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General NPI Number Information
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NPI Number | 1427797620
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Entity Type | Organization
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Legal Business Name | BOUNCE BACK PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 385 LAKEVIEW AVE STE 3
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City | CLIFTON
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State | NJ
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Zip | 07011-4075
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Country | US
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Telephone | 962-259-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 385 LAKEVIEW AVE STE 3
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City | CLIFTON
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State | NJ
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Zip | 07011-4075
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Country | US
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Telephone | 862-259-2555
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | AMMAR MUSTAFA
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Credential | DPT
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Telephone | 862-668-3629
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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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