Provider Demographics
NPI:1063950343
Name:SPINAL MOTION DIAGNOSTICS FORT LAUDERDALE LLC
Entity type:Organization
Organization Name:SPINAL MOTION DIAGNOSTICS FORT LAUDERDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-685-5343
Mailing Address - Street 1:5333 N DIXIE HWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3414
Mailing Address - Country:US
Mailing Address - Phone:954-616-8076
Mailing Address - Fax:
Practice Address - Street 1:8435 MAN O WAR ROAD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418
Practice Address - Country:US
Practice Address - Phone:954-685-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINAL MOTION DIAGNOSTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology