Provider Demographics
NPI:1821598731
Name:BACK TO NORMAL, LLC
Entity Type:Organization
Organization Name:BACK TO NORMAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-437-1937
Mailing Address - Street 1:217 E INTENDENCIA ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6022
Mailing Address - Country:US
Mailing Address - Phone:850-512-0711
Mailing Address - Fax:800-785-5684
Practice Address - Street 1:217 E INTENDENCIA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6022
Practice Address - Country:US
Practice Address - Phone:850-437-1937
Practice Address - Fax:800-785-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18460332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies