Healthcare Provider Details

I. General information

NPI: 1730398793
Provider Name (Legal Business Name): FRONT TO BACK BASICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6971 N FEDERAL HWY SUITE 305
BOCA RATON FL
33487-1656
US

IV. Provider business mailing address

8577 BOCA GLADES BLVD W APT E
BOCA RATON FL
33434-4088
US

V. Phone/Fax

Practice location:
  • Phone: 561-241-4411
  • Fax: 561-241-4211
Mailing address:
  • Phone: 561-866-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11526
License Number StateFL

VIII. Authorized Official

Name: MS. MIRI INGWER
Title or Position: PRESIDENT
Credential: PT, CFMT
Phone: 561-241-4411