MEDICARE: BACK IN THE GAME THERAPY, P.C.

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	225100000X	Physical Therapist	014928-1	NY
2	2251X0800X	Orthopedic Physical Therapist	014928-1	NY
3	2251S0007X	Sports Physical Therapist	014928-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QP7701	OTHER		BCBS
2	P27955	OTHER	NY	OXFORD HEALTH PLANS

General Provider Information

NPI Number	:	1366425597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN THE GAME THERAPY, P.C.

Provider Business Mailing Address
First Line	:	575 LEXINGTON AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6146
Country	:	US
Telephone Number	:	646-286-7140
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 LEXINGTON AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6146
Country	:	US
Telephone Number	:	462-867-1406
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MONICA JOSHI
Credential	:	PT
Telephone Number	:	646-286-7140

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	03/31/2021

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Directions to “BACK IN THE GAME THERAPY, P.C. ” Practice Location

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