Provider Demographics
NPI:1730398793
Name:FRONT TO BACK BASICS INC
Entity type:Organization
Organization Name:FRONT TO BACK BASICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:INGWER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CFMT
Authorized Official - Phone:561-241-4411
Mailing Address - Street 1:8577 BOCA GLADES BLVD W APT E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4088
Mailing Address - Country:US
Mailing Address - Phone:561-866-5371
Mailing Address - Fax:
Practice Address - Street 1:6971 N FEDERAL HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1656
Practice Address - Country:US
Practice Address - Phone:561-241-4411
Practice Address - Fax:561-241-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6014Medicare ID - Type Unspecified