Healthcare Provider Details

I. General information

NPI: 1184946691
Provider Name (Legal Business Name): SPINAL HEALTH AND REHAB OF PUNTA GORDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 CROSS ST
PUNTA GORDA FL
33950-4828
US

IV. Provider business mailing address

324 CROSS ST
PUNTA GORDA FL
33950-4828
US

V. Phone/Fax

Practice location:
  • Phone: 941-205-2180
  • Fax: 941-205-2181
Mailing address:
  • Phone: 941-205-2180
  • Fax: 941-205-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberME102997
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN MICHAEL VAN NOSTRAND
Title or Position: OWNER/CHIROPRACTOR
Credential: BS DC
Phone: 941-205-2180