Provider Demographics
NPI:1316591134
Name:BACK TO HEALTH PT LLC
Entity Type:Organization
Organization Name:BACK TO HEALTH PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-902-5262
Mailing Address - Street 1:9 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1101
Mailing Address - Country:US
Mailing Address - Phone:516-902-5262
Mailing Address - Fax:
Practice Address - Street 1:103 S BEDFORD RD STE 109
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3452
Practice Address - Country:US
Practice Address - Phone:914-241-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy