Organization Name: | BACK TO LIFE PHYSICAL THERAPY, INC. |
NPI Number: | 1033220470 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN PETTENGILL (OFFICE MANAGER) |
Mailing Address: | 434 W Aaron Dr Suite 104 State College |
State: | PA US |
Postal Code: | 168033074 |
Phone Number: | 8142359995 |
Fax Number: | 8142359616 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |