Provider Demographics
NPI:1568182947
Name:SCOTTSDALE SCOLIOSIS & SPINE THERAPY INC
Entity Type:Organization
Organization Name:SCOTTSDALE SCOLIOSIS & SPINE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:505-980-9920
Mailing Address - Street 1:342 SOLANO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1044
Mailing Address - Country:US
Mailing Address - Phone:505-980-9920
Mailing Address - Fax:
Practice Address - Street 1:10290 N 92ND ST STE 202A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4528
Practice Address - Country:US
Practice Address - Phone:505-980-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy