NPIMap

Organization Active NPI

Back on Track Therapy and Wellness, LLC

  • Physical Therapist
  • Lima, OH
National Provider Identifier
1043739436
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT016035 Issued in OH
Legal business name
BACK ON TRACK THERAPY AND WELLNESS, LLC
Practice address
3477 S Dixie Hwy
Lima, OH 45804-3706
Phone
(567) 356-4385
Fax
(419) 738-8002
NPI assigned
Sep 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shaun Cameron DennisNPI 1841667946
Title
Owner
Phone
(567) 356-4385

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT016035 OH Primary

Addresses

Primary practice location

3477 S Dixie Hwy
Lima, OH 45804-3706

Mailing address

3477 S Dixie Hwy
Lima, OH 45804-3706
Phone (567) 356-4385

Other practice location 1

4030 Allentown Rd Ste 2
Lima, OH 45807-2146
Phone (567) 356-4385

Other names 1

  • Back on Track Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181203001757 OH Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0749524775 Receives reassigned benefits from 4 practitioners
Practice locations: Lima, OH

National Provider Directory

National Provider Directory

Locations

4030 Allentown Rd
Ste 2
Lima, OH 45807
Phone (567) 356-4385

16 E Auglaize St
Wapakoneta, OH 45895
Phone (567) 242-6377

610 N Dixie Hwy
Wapakoneta, OH 45895
Phone (673) 564-3855

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1043739436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3477 S DIXIE HWY",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458043706",
            "telephone_number": "567-356-4385",
            "fax_number": "419-738-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3477 S DIXIE HWY",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458043706",
            "telephone_number": "567-356-4385",
            "fax_number": "419-738-8002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4030 Allentown Rd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "458072146",
            "country_code": "US",
            "telephone_number": "567-356-4385",
            "fax_number": "419-738-8002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BACK ON TRACK THERAPY AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-17",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "CAMERON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "567-356-4385"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT016035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back on Track Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lima, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.