Provider Demographics
NPI:1568428340
Name:SPINE REHABILITATION AND REEDUCATION CENTER OF NORTH
Entity Type:Organization
Organization Name:SPINE REHABILITATION AND REEDUCATION CENTER OF NORTH
Other - Org Name:SOUTHWIND SPINE REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:919-382-0082
Mailing Address - Street 1:2309 SPARGER RD
Mailing Address - Street 2:POB 2403
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2227
Mailing Address - Country:US
Mailing Address - Phone:919-382-0082
Mailing Address - Fax:919-383-9112
Practice Address - Street 1:2309 SPARGER RD
Practice Address - Street 2:POB 2403
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2227
Practice Address - Country:US
Practice Address - Phone:919-382-0082
Practice Address - Fax:919-383-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346570Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER