Provider Demographics
NPI:1801236450
Name:GOTYOURBACK
Entity type:Organization
Organization Name:GOTYOURBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRONWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPERTUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-834-3992
Mailing Address - Street 1:521 E HECTOR ST
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1920
Mailing Address - Country:US
Mailing Address - Phone:610-834-3992
Mailing Address - Fax:
Practice Address - Street 1:521 E HECTOR ST
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1920
Practice Address - Country:US
Practice Address - Phone:610-834-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment