Provider Demographics
NPI:1396825063
Name:BACK IN BALANCE PHYSICAL THERAPY AND SPORT REHABILITATION, PLLC
Entity Type:Organization
Organization Name:BACK IN BALANCE PHYSICAL THERAPY AND SPORT REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PIENKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-692-2225
Mailing Address - Street 1:726 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2653
Mailing Address - Country:US
Mailing Address - Phone:845-692-2225
Mailing Address - Fax:845-692-2239
Practice Address - Street 1:726 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2653
Practice Address - Country:US
Practice Address - Phone:845-692-2225
Practice Address - Fax:845-692-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty