Basic Information
| Provider Information | |||||||||
| NPI: | 1689270605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BACK TO YOU ROYAL OAK, 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 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2020 | ||||||||
| LastUpdateDate: | 12/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | PUTNAM | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2487334325 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BACK TO YOU REHAB PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPT | ||||||||
| NPICertificationDate: | 12/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.