=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447437488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINAL REHAB SOLUTIONS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2008
-----------------------------------------------------
Last Update Date | 10/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1452 W HORIZON RIDGE PKWY STE 565
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89012-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-586-5107
-----------------------------------------------------
Fax | 888-586-5108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 177 CASSIA WAY STE B111
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-6646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-586-5107
-----------------------------------------------------
Fax | 888-586-5108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RACHEL FONTANA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-586-5107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------