Provider Demographics
NPI:1730281262
Name:BACK ON YOUR FEET PT, PLLC
Entity Type:Organization
Organization Name:BACK ON YOUR FEET PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-368-2571
Mailing Address - Street 1:2232 BRIGHAM ST
Mailing Address - Street 2:APT. #3E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6141
Mailing Address - Country:US
Mailing Address - Phone:718-368-2571
Mailing Address - Fax:718-934-6430
Practice Address - Street 1:2232 BRIGHAM ST
Practice Address - Street 2:APT. #3E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-6141
Practice Address - Country:US
Practice Address - Phone:718-368-2571
Practice Address - Fax:718-934-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020227-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL5281Medicare UPIN