Provider Demographics
NPI:1396066239
Name:SPINE THERAPY INC
Entity type:Organization
Organization Name:SPINE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RONZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-697-2341
Mailing Address - Street 1:2300 E. NORVELL BRYAUT HWY
Mailing Address - Street 2:SPINE THERAPY INC
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-8902
Mailing Address - Country:US
Mailing Address - Phone:352-341-4778
Mailing Address - Fax:352-341-4477
Practice Address - Street 1:4211 W BOY SCOUT BLVD STE 400
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5766
Practice Address - Country:US
Practice Address - Phone:813-443-2108
Practice Address - Fax:813-443-8255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULFCOAST SPINE INSTITUTE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-15
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY927LOtherBLUE SHIELD
FLDF4724OtherRAIL ROAD MEDICARE
FLY927LOtherBLUE SHIELD