Provider Demographics
NPI:1285602193
Name:BOUNCE BACK PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:BOUNCE BACK PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:EVORA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:212-741-5544
Mailing Address - Street 1:430 W 24TH ST
Mailing Address - Street 2:SUITE 1-F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1334
Mailing Address - Country:US
Mailing Address - Phone:212-741-5544
Mailing Address - Fax:212-741-5895
Practice Address - Street 1:430 W 24TH ST
Practice Address - Street 2:SUITE 1-F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1334
Practice Address - Country:US
Practice Address - Phone:212-741-5544
Practice Address - Fax:212-741-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020224261QP2000X
NY013912261QP2000X
NJ027038261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22R21Medicare ID - Type Unspecified
NYQ22R31Medicare ID - Type Unspecified
NYQ5W7G1Medicare PIN