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General NPI Number Information
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NPI Number | 1346751484
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Entity Type | Organization
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Legal Business Name | BACK TO NORMAL II LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 53 SADDLE ROWE LN
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City | NORTH SCITUATE
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State | RI
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Zip | 02857-1271
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Country | US
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Telephone | 401-749-0539
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT # 880237 PO BOX 29650
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City | PHOENIX
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State | AZ
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Zip | 85038-9650
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Country | US
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Telephone | 800-310-7334
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN K CZERWEIN JR.
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Credential | MD
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Telephone | 800-310-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number | MD12647
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License Number State | RI
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