Provider Demographics
NPI:1023154531
Name:BACK-2-LIFE PHYSICAL THERAPY, P.A.
Entity type:Organization
Organization Name:BACK-2-LIFE PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-797-0500
Mailing Address - Street 1:2905 RIGSBY LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4828
Mailing Address - Country:US
Mailing Address - Phone:727-797-0500
Mailing Address - Fax:727-797-0050
Practice Address - Street 1:2905 RIGSBY LN
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4828
Practice Address - Country:US
Practice Address - Phone:727-797-0500
Practice Address - Fax:727-797-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLU0235Z225100000X
FLU0292Z225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0235ZMedicare ID - Type UnspecifiedNEIL DIOLA
FLU0292ZMedicare ID - Type UnspecifiedLORNA DIOLA