Healthcare Provider Details

I. General information

NPI: 1205204633
Provider Name (Legal Business Name): INTERNATIONAL SPINE AND SPORTS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 PALM SPRINGS DR SUITE A
ALTAMONTE SPRINGS FL
32701-7838
US

IV. Provider business mailing address

652 PALM SPRINGS DR SUITE A
ALTAMONTE SPRINGS FL
32701-7838
US

V. Phone/Fax

Practice location:
  • Phone: 407-947-3081
  • Fax:
Mailing address:
  • Phone: 407-947-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KATZMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 407-947-3081