Provider Demographics
NPI:1801112404
Name:SPINE CONSULTANTS LLC
Entity type:Organization
Organization Name:SPINE CONSULTANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-643-0300
Mailing Address - Street 1:9225 N 3RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2439
Mailing Address - Country:US
Mailing Address - Phone:602-643-0300
Mailing Address - Fax:602-643-0038
Practice Address - Street 1:9225 N 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2439
Practice Address - Country:US
Practice Address - Phone:602-643-0300
Practice Address - Fax:602-643-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy