Provider Demographics
NPI:1619279023
Name:BACK TO YOU PHYSICAL THERAPY AND SPORTS MEDICINE INC.
Entity Type:Organization
Organization Name:BACK TO YOU PHYSICAL THERAPY AND SPORTS MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:PIETROMONACO
Authorized Official - Last Name:MURFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:508-545-2352
Mailing Address - Street 1:19 N MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1553
Mailing Address - Country:US
Mailing Address - Phone:508-545-2352
Mailing Address - Fax:508-545-2354
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SHERBORN
Practice Address - State:MA
Practice Address - Zip Code:01770-1553
Practice Address - Country:US
Practice Address - Phone:508-545-2352
Practice Address - Fax:508-545-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT11893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPTAN0020141Medicare PIN