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
1180 BEACON ST, SUITE 6-C, BROOKLINE, MA 02446-3838
(617) 730-5337
(617) 730-5461
Mailing address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(401) 946-4250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
MA
225X00000X
Occupational Therapist
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y65633
BCBSMA GROUP #
MA
Enumeration date
05/11/2006
Last updated
04/20/2012
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