| Organization Name: | BACK ON TRACK PHYSICAL THERAPY PLLC |
| NPI Number: | 1366787145 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JASON JOSEPH WEEKS (OWNER/ PHYSICAL THERAPIST) |
| Mailing Address: | 472 Montauk Hwy Unit #2 East Quogue |
| State: | NY US |
| Postal Code: | 119423930 |
| Phone Number: | 6317661991 |
| Fax Number: | 6317287029 |
| NPI Enumeration Date: | 12/04/2012 |
| NPI Last Update Date: | 12/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 020636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |