Provider Demographics
NPI:1639694383
Name:ORTHOPEDIC SPINE & SPORTS INC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPINE & SPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-340-1100
Mailing Address - Street 1:2558 N SQUIRREL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2383
Mailing Address - Country:US
Mailing Address - Phone:248-340-1100
Mailing Address - Fax:248-340-1101
Practice Address - Street 1:480 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2006
Practice Address - Country:US
Practice Address - Phone:248-340-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC SPINE & SPORTS THERAPY AH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy