Provider Demographics
NPI:1689270605
Name:BACK TO YOU ROYAL OAK, PLLC
Entity Type:Organization
Organization Name:BACK TO YOU ROYAL OAK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-733-4325
Mailing Address - Street 1:2512 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3635
Mailing Address - Country:US
Mailing Address - Phone:248-733-4325
Mailing Address - Fax:
Practice Address - Street 1:2512 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3635
Practice Address - Country:US
Practice Address - Phone:248-733-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK TO YOU REHAB PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy