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General NPI Number Information
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NPI Number | 1255935888
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Entity Type | Organization
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Legal Business Name | BACK TO BALANCE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 545 HOOKSETT RD UNIT 20
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City | MANCHESTER
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State | NH
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Zip | 03104-2654
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Country | US
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Telephone | 603-232-5186
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Fax | 603-622-3199
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Provider Business Mailing Address
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Address Line | 545 HOOKSETT RD UNIT 20
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City | MANCHESTER
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State | NH
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Zip | 03104-2654
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Country | US
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Telephone | 603-232-5186
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Fax | 603-622-3199
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. KELLY SUSAN HEBERT-RUGGIO
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Credential | DPT
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Telephone | 603-232-5186
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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 |
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License Number State |
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