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General NPI Number Information
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NPI Number | 1407211097
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Entity Type | Organization
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Legal Business Name | BACK TO FORM PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 18 E 41ST ST SUITE 406
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City | NEW YORK
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State | NY
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Zip | 10017-6222
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Country | US
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Telephone | 212-725-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 485 CENTRAL PARK W APT 3F
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City | NEW YORK
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State | NY
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Zip | 10025-3360
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Country | US
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Telephone | 212-227-7310
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Fax | 917-591-4477
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Authorized Official
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Title or Position | OWNER
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Name | KYLE WARNER
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Credential |
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Telephone | 917-291-8656
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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 | 025701
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License Number State | NY
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