Provider Demographics
NPI:1558512160
Name:SPINE AND MUSCLE REABILATION
Entity Type:Organization
Organization Name:SPINE AND MUSCLE REABILATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-127-3473
Mailing Address - Street 1:10400 ACADAMY NE
Mailing Address - Street 2:STE 313
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-217-3473
Mailing Address - Fax:
Practice Address - Street 1:10400 ACADEMY RD NE
Practice Address - Street 2:STE 313
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1229
Practice Address - Country:US
Practice Address - Phone:505-217-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service