Provider Demographics
NPI:1295483980
Name:BACK TO IT THERAPY LLC
Entity type:Organization
Organization Name:BACK TO IT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:REHKEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:480-696-1050
Mailing Address - Street 1:3285 SILVER SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:LK HAVASU CTY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-6263
Mailing Address - Country:US
Mailing Address - Phone:469-230-9158
Mailing Address - Fax:
Practice Address - Street 1:3285 SILVER SADDLE DR
Practice Address - Street 2:(I WILL BE A MOBILE PRACTICE WITHOUT PRIMARY LOCATION)
Practice Address - City:LK HAVASU CTY
Practice Address - State:AZ
Practice Address - Zip Code:86406-6263
Practice Address - Country:US
Practice Address - Phone:469-230-9158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-13
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty