Provider Demographics
NPI:1164663563
Name:SPINE AND ORTHOPEDIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:SPINE AND ORTHOPEDIC SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-623-4171
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 3302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-623-4171
Mailing Address - Fax:302-623-4149
Practice Address - Street 1:1101 TWIN C LN STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2159
Practice Address - Country:US
Practice Address - Phone:302-633-1280
Practice Address - Fax:302-633-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000743261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1790739829OtherNPI
DE490978Medicare UPIN