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General NPI Number Information
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NPI Number | 1639102650
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Entity Type | Organization
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Legal Business Name | CENTER FOR SPINE, JOINT & NEUROMUSCULAR REHABILITATION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 5003 CROSSING CIRCLE SUITE 200
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City | MT. JULIET
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State | TN
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Zip | 37122-8568
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Country | US
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Telephone | 615-872-9966
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Fax | 615-564-9300
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Provider Business Mailing Address
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Address Line | 5003 CROSSING CIRCLE SUITE 200
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City | MT. JULIET
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State | TN
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Zip | 37122-8568
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Country | US
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Telephone | 615-872-9966
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Fax | 615-564-9300
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MR. SON DIEP LE
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Credential | MD
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Telephone | 615-872-9966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35117
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License Number State | TN
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