Provider Demographics
NPI:1356372445
Name:BACK IN ACTION REHABILITATION, S.C.
Entity type:Organization
Organization Name:BACK IN ACTION REHABILITATION, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WUNSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-922-7776
Mailing Address - Street 1:103 S PIONEER RD # 100
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3871
Mailing Address - Country:US
Mailing Address - Phone:920-922-7776
Mailing Address - Fax:920-922-2938
Practice Address - Street 1:103 S PIONEER RD # 100
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3871
Practice Address - Country:US
Practice Address - Phone:920-922-7776
Practice Address - Fax:920-922-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40416300Medicaid