Provider Demographics
NPI:1639102650
Name:CENTER FOR SPINE, JOINT & NEUROMUSCULAR REHABILITATION
Entity Type:Organization
Organization Name:CENTER FOR SPINE, JOINT & NEUROMUSCULAR REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SON
Authorized Official - Middle Name:DIEP
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-872-9966
Mailing Address - Street 1:5003 CROSSING CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8568
Mailing Address - Country:US
Mailing Address - Phone:615-872-9966
Mailing Address - Fax:615-564-9300
Practice Address - Street 1:5003 CROSSING CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8568
Practice Address - Country:US
Practice Address - Phone:615-872-9966
Practice Address - Fax:615-564-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35117208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377082Medicaid
TN5736840001Medicare NSC
TN3377082Medicare PIN
TNG95265Medicare UPIN