Provider Demographics
NPI:1578670873
Name:ON THE RIGHT TRACK CORP
Entity Type:Organization
Organization Name:ON THE RIGHT TRACK CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOME
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-558-3316
Mailing Address - Street 1:5929 KILLARNEY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2350
Mailing Address - Country:US
Mailing Address - Phone:561-558-3316
Mailing Address - Fax:
Practice Address - Street 1:5929 KILLARNEY CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-2350
Practice Address - Country:US
Practice Address - Phone:561-558-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6659261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8452Medicare ID - Type UnspecifiedPROVIDER NUMBER