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General NPI Number Information
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NPI Number | 1679906176
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Entity Type | Organization
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Legal Business Name | SPINE & SPORTS REHABILITATION INSTITUTE
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 2600 E. SOUTHERN AVE. I-1
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City | TEMPE
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State | AZ
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Zip | 85282-7738
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Country | US
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Telephone | 480-420-3600
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Fax | 480-420-3644
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Provider Business Mailing Address
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Address Line | 2600 E. SOUTHERN AVE. I-1
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City | TEMPE
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State | AZ
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Zip | 85282-7738
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Country | US
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Telephone | 480-420-3600
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Fax | 480-420-3644
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Authorized Official
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Title or Position | MANAGER
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Name | DR. PAUL S SRAOW
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Credential | M.D.
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Telephone | 480-420-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 46748
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License Number State | AZ
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