Provider Demographics
NPI:1992220693
Name:BACK TO MOTION PHYSICAL THERAPY & REHABILITATION INC
Entity Type:Organization
Organization Name:BACK TO MOTION PHYSICAL THERAPY & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-318-5303
Mailing Address - Street 1:171 ELMORA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1169
Mailing Address - Country:US
Mailing Address - Phone:908-469-9484
Mailing Address - Fax:908-838-9727
Practice Address - Street 1:171 ELMORA AVE FL 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1169
Practice Address - Country:US
Practice Address - Phone:908-469-9484
Practice Address - Fax:908-838-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty