Provider Demographics
NPI:1174712178
Name:BACK TO HEALTH PHYSICAL THERAPY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:BACK TO HEALTH PHYSICAL THERAPY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT,MS,OCS
Authorized Official - Phone:201-833-0234
Mailing Address - Street 1:316 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3025
Mailing Address - Country:US
Mailing Address - Phone:201-833-0234
Mailing Address - Fax:
Practice Address - Street 1:316 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3025
Practice Address - Country:US
Practice Address - Phone:201-833-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01108500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100325Medicare PIN