Provider Demographics
NPI:1538128467
Name:BACK TO ACTION PHYSICAL THERAPY PLC
Entity Type:Organization
Organization Name:BACK TO ACTION PHYSICAL THERAPY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:PT ATC EDM
Authorized Official - Phone:802-496-5340
Mailing Address - Street 1:4740 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673
Mailing Address - Country:US
Mailing Address - Phone:802-496-5340
Mailing Address - Fax:802-496-4262
Practice Address - Street 1:4740 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673
Practice Address - Country:US
Practice Address - Phone:802-496-5340
Practice Address - Fax:802-496-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTBATK00058703OtherBCBS
VTBATK00058703OtherBCBS