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General NPI Number Information
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NPI Number | 1275510141
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Entity Type | Organization
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Legal Business Name | NEOSPINE PUYALLUP SPINE CENTER, LLC
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1519 3RD ST SE SUITE 102
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City | PUYALLUP
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State | WA
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Zip | 98372-3742
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Country | US
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Telephone | 253-841-0705
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Fax | 253-841-4527
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Provider Business Mailing Address
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Address Line | 1519 3RD ST SE SUITE 102
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City | PUYALLUP
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State | WA
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Zip | 98372-3742
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Country | US
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Telephone | 253-841-0705
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Fax | 253-841-4527
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | CATHIE BOYD ROSA
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Credential |
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Telephone | 253-604-1413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | WA
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