Provider Demographics
NPI:1417775420
Name:BACK TO FUNCTION PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BACK TO FUNCTION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PURWA
Authorized Official - Middle Name:SAPPAN
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:224-305-7004
Mailing Address - Street 1:113 MCHENRY RD UNIT 134
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1796
Mailing Address - Country:US
Mailing Address - Phone:224-305-7004
Mailing Address - Fax:
Practice Address - Street 1:386 W HALF DAY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6547
Practice Address - Country:US
Practice Address - Phone:224-305-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty