Healthcare Provider Details

I. General information

NPI: 1821024027
Provider Name (Legal Business Name): SPINE & SPORTS REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 E MAIN ST
HUMMELSTOWN PA
17036-1839
US

IV. Provider business mailing address

619 E MAIN ST
HUMMELSTOWN PA
17036-1839
US

V. Phone/Fax

Practice location:
  • Phone: 717-566-6000
  • Fax: 717-566-6698
Mailing address:
  • Phone: 717-566-6000
  • Fax: 717-566-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT STONER
Title or Position: OWNER
Credential: CHIROPRACTOR
Phone: 717-566-6000