Provider Demographics
NPI:1356588859
Name:BACK IN ACTION P A
Entity type:Organization
Organization Name:BACK IN ACTION P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:954-480-2900
Mailing Address - Street 1:1868 W HILLSBORO BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1448
Mailing Address - Country:US
Mailing Address - Phone:954-480-2900
Mailing Address - Fax:954-480-6569
Practice Address - Street 1:1868 W HILLSBORO BLVD STE D
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1448
Practice Address - Country:US
Practice Address - Phone:954-480-2900
Practice Address - Fax:954-480-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002416261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy