Organization
BACK ON TRACK, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY SISUN PT (PRESIDENT OWNER)
(617) 730-5337
Entity
Organization
Contact information
Practice address
1269 BEACON ST, 2ND FLOOR, BROOKLINE, MA 02446-5248
(617) 730-5337
Mailing address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(617) 730-5337
(617) 730-5461
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
38
MA
Other
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
Enumeration date
01/22/2007
Last updated
12/07/2011
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