MEDICARE: SPINE AND REHABILITATION CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XS0117X	Orthopaedic Surgery of the Spine Physician
2	363A00000X	Physician Assistant
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
4	225100000X	Physical Therapist
5	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1841208022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	3724 EXECUTIVE CENTER DR
Second Line	:	SUITE G-10
City	:	AUSTIN
State	:	TX
Zip	:	78731-1646
Country	:	US
Telephone Number	:	512-345-5925
Fax Number	:	512-343-7113

Provider Business Practice Location Address
First Line	:	3724 EXECUTIVE CENTER DR
Second Line	:	SUITE G-10
City	:	AUSTIN
State	:	TX
Zip	:	78731-1646
Country	:	US
Telephone Number	:	512-345-5925
Fax Number	:	512-343-7113

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JODI ATCHLEY
Credential	:
Telephone Number	:	512-345-5935

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/14/2008

Similar Medicare Providers

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Practice Location Address:

3724 EXECUTIVE CENTER DR , SUITE G10
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78731-1646

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1114935988 — TRENT L. MCGINTY P.T.
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3724 EXECUTIVE CENTER DR , SUITE G-10
AUSTIN, TX
78731-1646

Practice Phone: 512-345-5925
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1316959109 — HOME THERAPY OF AUSTIN LLC
Practice Location Address:

3724 EXECUTIVE CENTER DR STE 220C
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Practice Location Address:

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1275647778 — RAYMOND NOFI P.T.
Practice Location Address:

3724 EXECUTIVE CENTER DR , SUITE G-10
AUSTIN, TX
78731-1646

Practice Phone: 512-345-5925
Practice Fax: 512-343-7113

Directions to “SPINE AND REHABILITATION CENTER ” Practice Location

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