Healthcare Provider Details

I. General information

NPI: 1245945328
Provider Name (Legal Business Name): CARE SPINE AND SPORTS HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 W NEW HAVEN AVE
WEST MELBOURNE FL
32904-3705
US

IV. Provider business mailing address

629 HUMMINGBIRD DR
INDIALANTIC FL
32903-4772
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-8626
  • Fax: 800-813-9164
Mailing address:
  • Phone: 440-465-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: HART MEYRICH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 407-340-9039