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General NPI Number Information
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NPI Number | 1538473632
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Entity Type | Organization
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Legal Business Name | BACK ON TRACK LLC
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 842 HOLMES AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2749
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Country | US
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Telephone | 847-997-5304
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Fax |
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Provider Business Mailing Address
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Address Line | 842 HOLMES AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2749
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Country | US
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Telephone | 847-997-5304
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GALINA FARBMAN MARTIROSYAN
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Credential | PT
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Telephone | 847-997-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 070009820
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License Number State | IL
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