The Back Program

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6296 Issued in MN

Legal business name

THE BACK PROGRAM

Practice address

1414 So Oak Ave
Ste 2 Owatonna Physical Therapy Center Inc
Owatonna, MN 55060-3957

Phone

(507) 451-8254

Fax

(507) 451-7324

NPI assigned

May 17, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Ellen Peterson

Title

Ceo

Phone

(507) 451-8254

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1274054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1972821874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 SO OAK AVE",
            "address_2": "SUITE 2 OWATONNA PHYSICAL THERAPY CENTER INC",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550603957",
            "telephone_number": "507-451-8254",
            "fax_number": "507-451-7324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 SO OAK AVE",
            "address_2": "STE 2 OWATONNA PHYSICAL THERAPY CENTER INC",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550603957",
            "telephone_number": "507-451-8254",
            "fax_number": "507-451-7324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BACK PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-17",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-451-8254",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlee Marie Tackmann, PA
• Liza Tapia, C.N.P.
• Brooke-Lynn Olivia Taylor, DPT
• Halie Marie Teske, PA-C
• Samuel John Testa, RPH.
• Thompson Dental PLLC
• Bradley F Thompson, MD
• Kaneisha Monique Thompson
• Lacey Theresa Thompson, MSW, LICSW
• Shellie Lynette Thompson, CRNA

• Physical Therapist in Owatonna, MN
• Providers in Owatonna, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; 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.