Back to Form Physical Therapy, PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

025701 Issued in NY

Legal business name

BACK TO FORM PHYSICAL THERAPY, PC

Practice address

18 E 41St St
Suite 406
New York, NY 10017-6222

Phone

(212) 725-6600

NPI assigned

Dec 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Warner

Title

Owner

Phone

(917) 291-8656

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1407211097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 CENTRAL PARK W APT 3F",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253360",
            "telephone_number": "212-227-7310",
            "fax_number": "917-591-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 E 41ST ST",
            "address_2": "SUITE 406",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176222",
            "telephone_number": "212-725-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO FORM PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-23",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-291-8656"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "025701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.