Healthcare Provider Details

I. General information

NPI: 1770081853
Provider Name (Legal Business Name): RL SPINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7671 CITA LN UNIT 101
NEW PORT RICHEY FL
34653-6223
US

IV. Provider business mailing address

7671 CITA LN UNIT 101
NEW PORT RICHEY FL
34653-6223
US

V. Phone/Fax

Practice location:
  • Phone: 727-339-3573
  • Fax: 727-339-3697
Mailing address:
  • Phone: 727-339-3573
  • Fax: 727-339-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10924
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1952841215
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT DE STEFANO JR.
Title or Position: OWNER
Credential: D.C.
Phone: 727-808-7542