Provider Demographics
NPI:1720579170
Name:BACK TO HEALTH PT, PLLC
Entity Type:Organization
Organization Name:BACK TO HEALTH PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CERT MDT
Authorized Official - Phone:773-491-3507
Mailing Address - Street 1:15408 SUNSET RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4922
Mailing Address - Country:US
Mailing Address - Phone:773-491-3507
Mailing Address - Fax:
Practice Address - Street 1:11824 SOUTHWEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2662
Practice Address - Country:US
Practice Address - Phone:708-923-1919
Practice Address - Fax:708-923-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty