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General NPI Number Information
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NPI Number | 1619923026
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Entity Type | Organization
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Legal Business Name | SPORTS AND SPINE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 3365 RICHMOND RD STE 110
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City | BEACHWOOD
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State | OH
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Zip | 44122-4171
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Country | US
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Telephone | 216-593-7070
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Fax | 216-593-7074
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Provider Business Mailing Address
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Address Line | 3355 RICHMOND RD SUITE 101A
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City | BEACHWOOD
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State | OH
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Zip | 44122-4100
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Country | US
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Telephone | 216-593-7070
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Fax |
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Authorized Official
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Title or Position | REGIONAL ADMINISTRATOR
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Name | TIFFANY MARIE WASSON
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Credential |
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Telephone | 216-593-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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