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General NPI Number Information
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NPI Number | 1215127428
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Entity Type | Organization
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Legal Business Name | SPINE SPORTS AND REHABILITATION SPECIALISTS PA
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 4000 SAWYER RD
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City | SARASOTA
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State | FL
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Zip | 34233-1272
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Country | US
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Telephone | 941-923-0999
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Fax | 941-923-0090
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Provider Business Mailing Address
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Address Line | 4000 SAWYER RD
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City | SARASOTA
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State | FL
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Zip | 34233-1272
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Country | US
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Telephone | 941-923-0999
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Fax | 941-923-0090
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Authorized Official
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Title or Position | OWNER
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Name | BRAM RIEGEL
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Credential |
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Telephone | 941-923-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 0066774
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License Number State | FL
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