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General NPI Number Information
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NPI Number | 1942226758
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Entity Type | Organization
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Legal Business Name | SPINE AND SPORTS MEDICINE INSTITUTE, INC.
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/15/2014
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Provider Practice Location Address
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Address Line | 2600 STANWELL DR SUITE 104
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City | CONCORD
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State | CA
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Zip | 94520-4862
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Country | US
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Telephone | 925-686-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 STANWELL DRIVE SUITE 104
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City | CONCORD
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State | CA
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Zip | 94520-4862
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Country | US
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Telephone | 925-686-5400
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JESSICA DRISCOLL
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Credential |
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Telephone | 925-686-5400
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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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