Provider Demographics
NPI:1417906025
Name:BACKWAYS PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BACKWAYS PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BACKWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-777-8050
Mailing Address - Street 1:250 S MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4714
Mailing Address - Country:US
Mailing Address - Phone:928-777-8050
Mailing Address - Fax:928-443-9029
Practice Address - Street 1:250 S MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4714
Practice Address - Country:US
Practice Address - Phone:928-777-8050
Practice Address - Fax:928-443-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ 0462680OtherBCBS
AZ0187237OtherUS DEPARTMENT OF LABOR
AZAZ 0462680OtherBCBS
AZZ81774Medicare ID - Type Unspecified