Provider Demographics
NPI:1841034410
Name:BACK9PT & PERFORMANCE LLC
Entity type:Organization
Organization Name:BACK9PT & PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, SCS, FAAOMPT
Authorized Official - Phone:270-670-4733
Mailing Address - Street 1:1105 BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1648
Mailing Address - Country:US
Mailing Address - Phone:270-670-4733
Mailing Address - Fax:
Practice Address - Street 1:9000 LIMEHOUSE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3843
Practice Address - Country:US
Practice Address - Phone:502-491-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy