Provider Demographics
NPI:1386678639
Name:SPINEWORKS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SPINEWORKS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-466-7095
Mailing Address - Street 1:5665 LOWERY RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2220
Mailing Address - Country:US
Mailing Address - Phone:757-466-7095
Mailing Address - Fax:757-466-1957
Practice Address - Street 1:5665 LOWERY RD
Practice Address - Street 2:SUITE #200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2220
Practice Address - Country:US
Practice Address - Phone:757-466-7095
Practice Address - Fax:757-466-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty