Provider Demographics
NPI:1427283936
Name:SPINESCOTTSDALE, PLLC
Entity type:Organization
Organization Name:SPINESCOTTSDALE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-584-3334
Mailing Address - Street 1:10277 N 92ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4564
Mailing Address - Country:US
Mailing Address - Phone:480-584-3334
Mailing Address - Fax:480-272-9369
Practice Address - Street 1:10277 N 92ND ST STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4564
Practice Address - Country:US
Practice Address - Phone:480-584-3334
Practice Address - Fax:480-272-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133483Medicare PIN