# BACK ON TRACK, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255484168
- **Authorized official:** MR. HENRY SISUN PT (PRESIDENT OWNER)
- **Authorized official phone:** (617) 730-5337

## Contact information

- **Practice address:** 1269 BEACON ST, 2ND FLOOR, BROOKLINE, MA 02446-5248
- **Practice address phone:** (617) 730-5337
- **Mailing address:** 721 RESERVOIR AVE, CRANSTON, RI 02910-4430
- **Mailing address phone:** (617) 730-5337
- **Mailing address fax:** (617) 730-5461

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 38 | MA | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 12/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 605716 | HPHC LEGACY | MA |
| 01 | — | OG0001 | BC LEGACY OT SERVICES | MA |
| 01 | — | Y65633 | BC LEGACY PT SERVICES | MA |