Provider Demographics
NPI:1558468785
Name:BACK ON TRACK, P.C.
Entity Type:Organization
Organization Name:BACK ON TRACK, P.C.
Other - Org Name:BACK ON TRACK PHYSICAL THERAPY AND CONSULTING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MTC, STC, CPI
Authorized Official - Phone:970-346-6116
Mailing Address - Street 1:4835 W 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2047
Mailing Address - Country:US
Mailing Address - Phone:970-346-6116
Mailing Address - Fax:970-346-1226
Practice Address - Street 1:4835 W 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2047
Practice Address - Country:US
Practice Address - Phone:970-346-6116
Practice Address - Fax:970-346-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO465398Medicare ID - Type UnspecifiedGROUP PROVIDER ID NUMBER