Provider Demographics
NPI:1285267849
Name:BACK IN ACTION THERAPY OF LAS CRUCES
Entity type:Organization
Organization Name:BACK IN ACTION THERAPY OF LAS CRUCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-430-8648
Mailing Address - Street 1:4400 SONOMA RANCH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-222-0188
Mailing Address - Fax:575-652-4142
Practice Address - Street 1:4400 SONOMA RANCH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-222-0188
Practice Address - Fax:575-652-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty