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General NPI Number Information
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NPI Number | 1336521442
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Entity Type | Organization
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Legal Business Name | BACK TO WELLNESS PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 627 PENNSYLVANIA AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-1213
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Country | US
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Telephone | 908-469-4201
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Fax | 908-469-4202
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Provider Business Mailing Address
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Address Line | 627 PENNSYLVANIA AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-1213
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Country | US
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Telephone | 908-469-4201
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Fax | 908-469-4202
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Authorized Official
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Title or Position | OWNER
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Name | ALICIA L JOHN
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Credential |
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Telephone | 908-469-4201
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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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