| Organization Name: | BACK IN ACTION, SAINT LUCIE PHYSICAL THERAPY LLC |
| NPI Number: | 1407005812 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK SAPIO DOCUMENTO (OWNER) |
| Mailing Address: | 266 Nw Peacock Blvd Building 2 Suite 2-204 Port Saint Lucie |
| State: | FL US |
| Postal Code: | 349862271 |
| Phone Number: | 7724086630 |
| Fax Number: | 7724086750 |
| NPI Enumeration Date: | 09/10/2008 |
| NPI Last Update Date: | 04/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT20821 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |