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General NPI Number Information
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NPI Number | 1396825063
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Entity Type | Organization
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Legal Business Name | BACK IN BALANCE PHYSICAL THERAPY AND SPORT REHABILITATION, PLLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 726 E MAIN ST SUITE 102
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2653
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Country | US
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Telephone | 845-692-2225
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Fax | 845-692-2239
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Provider Business Mailing Address
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Address Line | 726 E MAIN ST SUITE 102
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2653
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Country | US
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Telephone | 845-692-2225
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Fax | 845-692-2239
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Authorized Official
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Title or Position | PARTNER
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Name | TOMASZ PIENKOWSKI
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Credential | PT
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Telephone | 845-692-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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