Provider Demographics
NPI:1114342813
Name:CENTER FOR SPINE JOINT AND NEUROMUSCULAR REHAB PC
Entity Type:Organization
Organization Name:CENTER FOR SPINE JOINT AND NEUROMUSCULAR REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-504-4838
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 712
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076
Mailing Address - Country:US
Mailing Address - Phone:615-872-9966
Mailing Address - Fax:615-872-9967
Practice Address - Street 1:397 WALLACE ROAD
Practice Address - Street 2:BLDG. C, SUITE 206
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-872-9966
Practice Address - Fax:615-872-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377082Medicaid