Provider Demographics
NPI:1699251256
Name:SPINEZONE MEDICAL FITNESS, INC.
Entity type:Organization
Organization Name:SPINEZONE MEDICAL FITNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER / CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:IVANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-432-4634
Mailing Address - Street 1:7525 METROPOLITAN DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4404
Mailing Address - Country:US
Mailing Address - Phone:844-316-7979
Mailing Address - Fax:866-813-1235
Practice Address - Street 1:2700 N MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6638
Practice Address - Country:US
Practice Address - Phone:619-432-4634
Practice Address - Fax:866-813-1235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINEZONE MEDICAL FITNESS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-17
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294658225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty