Back in Action, Saint Lucie Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT20821 Issued in FL

Legal business name

BACK IN ACTION, SAINT LUCIE PHYSICAL THERAPY LLC

Doing business as

Back In Action

Practice address

266 NW Peacock Blvd
Building 2 Suite 2-204
Port Saint Lucie, FL 34986-2271

Phone

(772) 408-6630

Fax

(772) 408-6750

NPI assigned

Sep 10, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Mark Sapio Documento

Title

Owner

Phone

(772) 408-6630

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Back In Action Doing business as

Locations

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1407005812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7666",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349857666",
            "telephone_number": "772-408-6630",
            "fax_number": "772-408-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 NW PEACOCK BLVD",
            "address_2": "BUILDING 2 SUITE 2-204",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862271",
            "telephone_number": "772-408-6630",
            "fax_number": "772-408-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK IN ACTION, SAINT LUCIE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-10",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "DOCUMENTO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SAPIO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-408-6630",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT20821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER TRANSACTION ACCESS NUMBER",
            "identifier": "BK845",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back In Action",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.