MEDICARE: BACK TO HEALTH PHYSICAL MEDICINE AND REHAB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1063810539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO HEALTH PHYSICAL MEDICINE AND REHAB INC

Provider Business Mailing Address
First Line	:	1611 TIFFIN AVE
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-6821
Country	:	US
Telephone Number	:	419-420-1555
Fax Number	:	419-420-1556

Provider Business Practice Location Address
First Line	:	1611 TIFFIN AVE
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-6821
Country	:	US
Telephone Number	:	419-420-1555
Fax Number	:	419-420-1556

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER BERRY
Credential	:	DC
Telephone Number	:	419-420-1555

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	11/30/2016

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