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General NPI Number Information
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NPI Number | 1639113251
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Entity Type | Organization
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Legal Business Name | SPORT AND SPINE PHYSICAL THERAPY AND REHAB SPECIALISTS
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 5245 JACKSON RD SUITE 2A
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City | ANN ARBOR
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State | MI
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Zip | 48103
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Country | US
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Telephone | 734-327-4716
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Fax | 734-327-4748
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Provider Business Mailing Address
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Address Line | PO BOX 3497
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City | STURTEVANT
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State | WI
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Zip | 53177-0300
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Country | US
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Telephone | 877-552-2996
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Fax | 866-245-8064
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Authorized Official
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Title or Position | CO-OWNER
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Name | LARRY D BRIAND
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Credential | MS, PT, ATC
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Telephone | 877-552-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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