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NPI Code Detail

MEDICARE: SPINE TECHNOLOGY AND REHABILITATION, P.C.

MEDICARE: SPINE TECHNOLOGY AND REHABILITATION, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1316920341
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPINE TECHNOLOGY AND REHABILITATION, P.C.
Provider Business Mailing Address
First Line : 1316 E 7TH ST
Second Line :
City : AUBURN
State : IN
Zip : 46706-2523
Country : US
Telephone Number : 260-459-7313
Fax Number :
Provider Business Practice Location Address
First Line : 1316 E 7TH ST
Second Line :
City : AUBURN
State : IN
Zip : 46706-2523
Country : US
Telephone Number : 260-459-7313
Fax Number :
Authorized Official
Title or Position : PHYSICIAN/EMPLOYEE
Name : JOSEPH D. FORTIN
Credential : D.O.
Telephone Number : 260-459-7313
Provider Enumeration Date : 11/23/2005
Last Update Date : 08/22/2020

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