MEDICARE: ALABAMA SPINE & REHABILITATION CENTER, LLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DR9703	OTHER		RR MEDICARE

General Provider Information

NPI Number	:	1689969156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA SPINE & REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	2017 CANYON RD
Second Line	:	SUITE 21
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1900
Country	:	US
Telephone Number	:	205-822-8320
Fax Number	:	205-822-8323

Provider Business Practice Location Address
First Line	:	2017 CANYON RD
Second Line	:	SUITE 21
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1900
Country	:	US
Telephone Number	:	205-822-8320
Fax Number	:	205-822-8323

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. THOMAS G SPURLOCK
Credential	:	D.C.
Telephone Number	:	205-822-8320

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	02/25/2013

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