Provider Demographics
NPI:1194606293
Name:EL PASO BACK IN ACTION THERAPY, LLC
Entity type:Organization
Organization Name:EL PASO BACK IN ACTION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
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 1:7451 PASEO DEL NORTE
Mailing Address - Street 2:SUITE B5
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911
Mailing Address - Country:US
Mailing Address - Phone:575-430-8648
Mailing Address - Fax:
Practice Address - Street 1:7451 PASEO DEL NORTE
Practice Address - Street 2:SUITE B5
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911
Practice Address - Country:US
Practice Address - Phone:575-430-8648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty