Provider Demographics
NPI:1396353587
Name:SPINE REHAB AT HOME LLC
Entity type:Organization
Organization Name:SPINE REHAB AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:314-626-3161
Mailing Address - Street 1:481 DANA MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6493
Mailing Address - Country:US
Mailing Address - Phone:314-626-3161
Mailing Address - Fax:314-200-2012
Practice Address - Street 1:481 DANA MEADOWS LN
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-6493
Practice Address - Country:US
Practice Address - Phone:314-626-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy