1285602193 NPI number — BOUNCE BACK PHYSICAL THERAPY, PC

Table of content: (NPI 1285602193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285602193 NPI number — BOUNCE BACK PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOUNCE BACK PHYSICAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285602193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 W 24TH ST
Provider Second Line Business Mailing Address:
SUITE 1-F
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10011-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-741-5544
Provider Business Mailing Address Fax Number:
212-741-5895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 W 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 1-F
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-741-5544
Provider Business Practice Location Address Fax Number:
212-741-5895
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EVORA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-741-5544

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  020224 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 013912 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 027038 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)