Provider Demographics
NPI:1801882451
Name:BACK-IN-ACTION PHYSICAL THERAPY CENTER OF KENOSHA, LTD.
Entity type:Organization
Organization Name:BACK-IN-ACTION PHYSICAL THERAPY CENTER OF KENOSHA, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SOLECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-925-9000
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53141-0158
Mailing Address - Country:US
Mailing Address - Phone:262-653-9208
Mailing Address - Fax:262-653-9264
Practice Address - Street 1:6123 GREEN BAY RD
Practice Address - Street 2:STE 140
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2927
Practice Address - Country:US
Practice Address - Phone:262-564-8334
Practice Address - Fax:262-653-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6483024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3907B3699000OtherBCBS OF WI