Healthcare Provider Details

I. General information

NPI: 1730847922
Provider Name (Legal Business Name): BACK TO LIFE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HARRY THOMAS WAY NE STE A
WASHINGTON DC
20002-4361
US

IV. Provider business mailing address

1501 HARRY THOMAS WAY NE STE A
WASHINGTON DC
20002-4361
US

V. Phone/Fax

Practice location:
  • Phone: 202-425-8245
  • Fax:
Mailing address:
  • Phone: 202-425-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TARIK CHASE
Title or Position: OWNER
Credential: PT
Phone: 202-425-8245