MEDICARE: BACK TO HEALTH LLC

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	2251X0800X	Orthopedic Physical Therapist	PT7613	FL

General Provider Information

NPI Number	:	1245426840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO HEALTH LLC

Provider Business Mailing Address
First Line	:	2840 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1814
Country	:	US
Telephone Number	:	954-565-0075
Fax Number	:	954-565-0085

Provider Business Practice Location Address
First Line	:	2840 EAST OAKLAND PARK BLVD.
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306
Country	:	US
Telephone Number	:	954-565-0075
Fax Number	:	954-565-0085

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. DARLENE S WOOLDRIDGE
Credential	:	P.T.
Telephone Number	:	954-565-0075

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	06/29/2012

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Directions to “BACK TO HEALTH LLC ” Practice Location

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