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General NPI Number Information
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NPI Number | 1750534814
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Entity Type | Organization
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Legal Business Name | BACK TO FUNCTION HOME PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/02/2008
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 49 SAILFISH DR
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City | BRIGANTINE
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State | NJ
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Zip | 08203-1347
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Country | US
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Telephone | 856-904-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 837 N 2ND ST APT 304
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3031
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Country | US
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Telephone | 856-904-5361
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK D ZAMEROWSKI
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Credential | MPT, MBA
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Telephone | 856-904-5361
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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 | 40QA00700300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT010623L
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License Number State | PA
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