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General NPI Number Information
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NPI Number | 1740514629
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Entity Type | Organization
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Legal Business Name | VITALITY SPINE & SPORTS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 15920 S RANCHO SAHUARITA BLVD SUITE 160
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City | SAHUARITA
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State | AZ
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Zip | 85629-8012
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Country | US
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Telephone | 520-867-8064
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Fax | 520-867-8063
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Provider Business Mailing Address
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Address Line | 15920 S RANCHO SAHUARITA BLVD STE 160
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City | SAHUARITA
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State | AZ
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Zip | 85629-8014
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Country | US
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Telephone | 520-867-8064
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Fax | 520-867-8063
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN C HINKLE
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Credential | PT
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Telephone | 520-867-8064
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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 | 4064
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License Number State | AZ
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