Healthcare Provider Details

I. General information

NPI: 1285602193
Provider Name (Legal Business Name): BOUNCE BACK PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W 24TH ST SUITE 1-F
NEW YORK NY
10011-1334
US

IV. Provider business mailing address

430 W 24TH ST SUITE 1-F
NEW YORK NY
10011-1334
US

V. Phone/Fax

Practice location:
  • Phone: 212-741-5544
  • Fax: 212-741-5895
Mailing address:
  • Phone: 212-741-5544
  • Fax: 212-741-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number013912
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number027038
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number020224
License Number StateNY

VIII. Authorized Official

Name: PAUL H EVORA
Title or Position: PRESIDENT
Credential: MS, PT
Phone: 212-741-5544