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General NPI Number Information
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NPI Number | 1366787145
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Entity Type | Organization
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Legal Business Name | BACK ON TRACK PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 472 MONTAUK HWY UNIT #2
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City | EAST QUOGUE
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State | NY
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Zip | 11942-3930
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Country | US
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Telephone | 631-766-1991
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Fax | 631-728-7029
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Provider Business Mailing Address
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Address Line | 9 BEECHNUT CT
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City | EAST QUOGUE
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State | NY
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Zip | 11942-4710
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Country | US
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Telephone | 631-766-1991
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Fax | 631-728-7029
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | MR. JASON JOSEPH WEEKS
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Credential | P.T.
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Telephone | 631-766-1991
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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 | 020636
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License Number State | NY
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