MEDICARE: NEUROSCIENCE AND SPINE ASSOCIATES PL

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1689445264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSCIENCE AND SPINE ASSOCIATES PL

Provider Business Mailing Address
First Line	:	3451 PINE RIDGE RD BLDG 601
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3922
Country	:	US
Telephone Number	:	239-449-3072
Fax Number	:	877-334-1886

Provider Business Practice Location Address
First Line	:	7273 VANDERBILT BEACH RD STE 33
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-1479
Country	:	US
Telephone Number	:	239-449-3072
Fax Number	:	877-334-1886

Authorized Official
Title or Position	:	CREDENTIALING ADMINISTRATOR
Name	:	CHERYL ANN LEACH
Credential	:
Telephone Number	:	239-449-3072

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	02/15/2024

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