Provider Demographics
NPI:1205973559
Name:BACKTOFITNESS
Entity type:Organization
Organization Name:BACKTOFITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-494-0991
Mailing Address - Street 1:744 SAN ANTONIO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4624
Mailing Address - Country:US
Mailing Address - Phone:650-494-0991
Mailing Address - Fax:650-494-0129
Practice Address - Street 1:744 SAN ANTONIO RD STE 3
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303
Practice Address - Country:US
Practice Address - Phone:650-494-0991
Practice Address - Fax:650-494-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy