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General NPI Number Information
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NPI Number | 1487787503
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF BACK TESTING & REHAB
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 540 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2802
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Country | US
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Telephone | 201-945-2320
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Fax | 201-945-5007
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Provider Business Mailing Address
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Address Line | 540 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2802
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Country | US
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Telephone | 201-945-2320
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Fax | 201-945-5007
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Authorized Official
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Title or Position | OWNER
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Name | MS. VINETA ZALITE
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Credential |
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Telephone | 201-945-2320
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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 | 40QA01198400
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License Number State | NJ
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