Provider Demographics
NPI:1306571161
Name:BACK TO YOU WELLNESS, LLC
Entity type:Organization
Organization Name:BACK TO YOU WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-891-5491
Mailing Address - Street 1:333 FRANKLIN WRIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1584
Mailing Address - Country:US
Mailing Address - Phone:248-891-5491
Mailing Address - Fax:
Practice Address - Street 1:3000 SW PORT ST LUCIE BLVD STE 3002
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3218
Practice Address - Country:US
Practice Address - Phone:248-891-5491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty