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General NPI Number Information
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NPI Number | 1306571161
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Entity Type | Organization
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Legal Business Name | BACK TO YOU WELLNESS, LLC
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Dates
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Enumeration Date | 07/17/2022
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Last Update Date | 07/17/2022
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Provider Practice Location Address
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Address Line | 3000 SW PORT ST LUCIE BLVD STE 3002
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3218
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Country | US
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Telephone | 248-891-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 333 FRANKLIN WRIGHT BLVD
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City | LAKE ORION
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State | MI
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Zip | 48362-1584
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Country | US
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Telephone | 248-891-5491
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN PUTNAM
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Credential | DPT
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Telephone | 248-891-5491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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