Provider Demographics
NPI:1912719709
Name:BACK2LIFE PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:BACK2LIFE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-809-8183
Mailing Address - Street 1:3625 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-6621
Mailing Address - Country:US
Mailing Address - Phone:847-809-8183
Mailing Address - Fax:
Practice Address - Street 1:3020 CORPORATE CT STE 400
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-5617
Practice Address - Country:US
Practice Address - Phone:847-809-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty