Healthcare Provider Details

I. General information

NPI: 1801112404
Provider Name (Legal Business Name): SPINE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST SUITE 300
PHOENIX AZ
85020-2439
US

IV. Provider business mailing address

9225 N 3RD ST SUITE 300
PHOENIX AZ
85020-2439
US

V. Phone/Fax

Practice location:
  • Phone: 602-643-0300
  • Fax: 602-643-0038
Mailing address:
  • Phone: 602-643-0300
  • Fax: 602-643-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY T SMITH
Title or Position: PT
Credential: PT
Phone: 602-643-0300