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General NPI Number Information
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NPI Number | 1831220839
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1731 SEAGIRT BLVD
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4513
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Country | US
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Telephone | 718-868-8668
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Fax |
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Provider Business Mailing Address
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Address Line | 458 BEACH 142 STR.
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694
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Country | US
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Telephone | 347-244-2530
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK VAYSMAN
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Credential | D.P.T.
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Telephone | 347-244-2530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | DDP3487
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 023238
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License Number State | NY
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