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General NPI Number Information
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NPI Number | 1215095385
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Entity Type | Organization
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Legal Business Name | BACK TO LIFE WELLNESS & REHABILITATION
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1930 MARLTON PIKE E SUITE E27
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2150
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Country | US
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Telephone | 856-424-6677
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Fax | 856-489-1803
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Provider Business Mailing Address
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Address Line | 1930 MARLTON PIKE E SUITE E27
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2150
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Country | US
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Telephone | 856-424-6677
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Fax | 856-489-1803
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | DR. MEGHAN RENDFREY MCDONOUGH
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Credential | DPT
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Telephone | 856-424-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | QA01105600
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License Number State | NJ
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