MEDICARE: SPINE ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1841401379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	20715 E OCOTILLO RD
Second Line	:	SUITE 103
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-6118
Country	:	US
Telephone Number	:	480-888-1558
Fax Number	:	480-888-1533

Provider Business Practice Location Address
First Line	:	20715 E OCOTILLO RD
Second Line	:	SUITE 103
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-6118
Country	:	US
Telephone Number	:	480-888-1558
Fax Number	:	480-888-1533

Authorized Official
Title or Position	:	PHYSICAL THERAPIST AND OWNER
Name	:	DR. JEFF CARR
Credential	:	D.P.T.
Telephone Number	:	480-888-1558

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	09/03/2013

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