Basic Information
| Provider Information | |||||||||
| NPI: | 1386124378 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BACK TO YOU REHAB PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2512 ROCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480733635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487334325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2512 ROCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480733635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487334325 | ||||||||
| FaxNumber: | 2482687979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2018 | ||||||||
| LastUpdateDate: | 01/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | PUTNAM | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2487334325 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | 01/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.