=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326715053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACKMAN HEALTH AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2021
-----------------------------------------------------
Last Update Date | 08/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 92ND ST UNIT 402
-----------------------------------------------------
City | BAY HARBOR ISLANDS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154-2889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-816-1067
-----------------------------------------------------
Fax | 929-312-3752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 92ND ST UNIT 402
-----------------------------------------------------
City | BAY HARBOR ISLANDS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154-2889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-816-1067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CHAIM BACKMAN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 917-816-1067
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------