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General NPI Number Information
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NPI Number | 1245426840
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH LLC
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 2840 EAST OAKLAND PARK BLVD.
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306
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Country | US
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Telephone | 954-565-0075
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Fax | 954-565-0085
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Provider Business Mailing Address
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Address Line | 2840 E OAKLAND PARK BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1814
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Country | US
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Telephone | 954-565-0075
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Fax | 954-565-0085
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. DARLENE S WOOLDRIDGE
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Credential | P.T.
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Telephone | 954-565-0075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT7613
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License Number State | FL
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