# BACK-IN-ACTION PHYSICAL THERAPY CENTER OF KENOSHA, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801882451
- **Authorized official:** MRS. KIMBERLY DENISE SOLECKI (BUSINESS MANAGER)
- **Authorized official phone:** (262) 925-9000

## Contact information

- **Practice address:** 6123 GREEN BAY RD, STE 140, KENOSHA, WI 53142-2927
- **Practice address phone:** (262) 564-8334
- **Practice address fax:** (262) 653-9264
- **Mailing address:** PO BOX 158, KENOSHA, WI 53141-0158
- **Mailing address phone:** (262) 653-9208
- **Mailing address fax:** (262) 653-9264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 6483024 | WI | Yes |

## Other

- **Enumeration date:** 09/20/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3907B3699000 | BCBS OF WI | — |