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General NPI Number Information
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NPI Number | 1144496472
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Entity Type | Organization
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Legal Business Name | SPINE SOLUTIONS, INC
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 2538 CAMINO ENTRADA STE. 300
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City | SANTA FE
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State | NM
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Zip | 87507-4919
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Country | US
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Telephone | 505-424-1239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33286
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City | SANTA FE
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State | NM
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Zip | 87594-3286
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Country | US
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Telephone | 505-424-1239
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Fax | 888-746-4761
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | GINA SANDOVAL
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Credential | PT, DPT, CEAS
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Telephone | 505-424-1239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1523
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License Number State | NM
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