Healthcare Provider Details

I. General information

NPI: 1184872012
Provider Name (Legal Business Name): BACK TO FUNCTION PHYSICAL THERAPY, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST STE 1406
NEW YORK NY
10019-2802
US

IV. Provider business mailing address

57 WEST 57 STREET SUITE 1406
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-399-3800
  • Fax: 212-399-3822
Mailing address:
  • Phone: 212-399-3800
  • Fax: 212-399-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number022400
License Number StateNY

VIII. Authorized Official

Name: MR. OSCAR F ALVAREZ
Title or Position: OWNER
Credential: P.T
Phone: 212-399-3800