Healthcare Provider Details

I. General information

NPI: 1073022281
Provider Name (Legal Business Name): BACK 2 SHAPE P.T. & O.T., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 E 2ND ST
BROOKLYN NY
11223-6041
US

IV. Provider business mailing address

2411 E 2ND ST
BROOKLYN NY
11223-6041
US

V. Phone/Fax

Practice location:
  • Phone: 718-909-5929
  • Fax: 718-942-5753
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MACHIAL KREYNER
Title or Position: PRESIDENT
Credential: DPT
Phone: 718-909-5929