Healthcare Provider Details

I. General information

NPI: 1386457000
Provider Name (Legal Business Name): CROSSTOWN SPINE & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 S US HIGHWAY 1
PORT ST LUCIE FL
34952-3333
US

IV. Provider business mailing address

173 MAIN ST
THOMASTON ME
04861-3807
US

V. Phone/Fax

Practice location:
  • Phone: 321-436-9343
  • Fax:
Mailing address:
  • Phone: 207-706-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN FARRELL
Title or Position: MANAGER
Credential:
Phone: 207-706-6810