Provider Demographics
NPI:1023539210
Name:BACK TO LIFE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BACK TO LIFE PHYSICAL THERAPY, INC.
Other - Org Name:BACK TO LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIN-COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-538-7878
Mailing Address - Street 1:329 BRYANT ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1444
Mailing Address - Country:US
Mailing Address - Phone:415-538-7878
Mailing Address - Fax:415-538-7818
Practice Address - Street 1:329 BRYANT ST STE 2A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1444
Practice Address - Country:US
Practice Address - Phone:415-538-7878
Practice Address - Fax:415-538-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy