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General NPI Number Information
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NPI Number | 1770081853
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Entity Type | Organization
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Legal Business Name | RL SPINE, PLLC
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 7671 CITA LN UNIT 101
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6223
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Country | US
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Telephone | 727-339-3573
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Fax | 727-339-3697
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Provider Business Mailing Address
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Address Line | 7671 CITA LN UNIT 101
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-6223
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Country | US
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Telephone | 727-339-3573
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Fax | 727-339-3697
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT DE STEFANO JR.
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Credential | D.C.
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Telephone | 727-808-7542
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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 | 1952841215
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH10924
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License Number State | FL
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