Provider Demographics
NPI:1528383932
Name:BACK TO BASICS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BACK TO BASICS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIELAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, LMT
Authorized Official - Phone:508-941-0004
Mailing Address - Street 1:555 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2537
Mailing Address - Country:US
Mailing Address - Phone:508-941-0004
Mailing Address - Fax:508-941-0001
Practice Address - Street 1:555 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2537
Practice Address - Country:US
Practice Address - Phone:508-941-0004
Practice Address - Fax:508-941-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2197261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy