Provider Demographics
NPI:1538915392
Name:BACK TO ME LLC
Entity type:Organization
Organization Name:BACK TO ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROTHESIS SP
Authorized Official - Phone:386-341-6256
Mailing Address - Street 1:2090 S NOVA RD STE A127
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8841
Mailing Address - Country:US
Mailing Address - Phone:386-341-6256
Mailing Address - Fax:
Practice Address - Street 1:2090 S NOVA RD STE A127
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8841
Practice Address - Country:US
Practice Address - Phone:386-341-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty