Provider Demographics
NPI:1730847922
Name:BACK TO LIFE PHYSICAL THERAPY
Entity type:Organization
Organization Name:BACK TO LIFE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:202-425-8245
Mailing Address - Street 1:1501 HARRY THOMAS WAY NE STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4361
Mailing Address - Country:US
Mailing Address - Phone:202-425-8245
Mailing Address - Fax:
Practice Address - Street 1:1501 HARRY THOMAS WAY NE STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4361
Practice Address - Country:US
Practice Address - Phone:202-425-8245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy