Provider Demographics
NPI:1578927240
Name:BACK TO HEALTH PHYSICAL OCCUPATIONAL AND MASSAGE THERAPY PLLC
Entity Type:Organization
Organization Name:BACK TO HEALTH PHYSICAL OCCUPATIONAL AND MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-434-4311
Mailing Address - Street 1:2565 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3530
Mailing Address - Country:US
Mailing Address - Phone:718-434-4311
Mailing Address - Fax:718-434-4355
Practice Address - Street 1:2565 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3530
Practice Address - Country:US
Practice Address - Phone:718-434-4311
Practice Address - Fax:718-434-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty