Provider Demographics
NPI:1861441842
Name:BACK IN ACTION INC
Entity Type:Organization
Organization Name:BACK IN ACTION INC
Other - Org Name:BACK IN ACTION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-557-3100
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1492
Mailing Address - Country:US
Mailing Address - Phone:919-557-3100
Mailing Address - Fax:919-557-3177
Practice Address - Street 1:100 FITNESS DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7263
Practice Address - Country:US
Practice Address - Phone:919-557-3100
Practice Address - Fax:919-557-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014Y2OtherBCBS