Provider Demographics
NPI:1689263618
Name:AMERICAN SPINE & SPORTS REHABILITATION GROUP LLC
Entity Type:Organization
Organization Name:AMERICAN SPINE & SPORTS REHABILITATION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:QUINTAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:786-370-2476
Mailing Address - Street 1:8181 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6671
Mailing Address - Country:US
Mailing Address - Phone:786-370-2476
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6671
Practice Address - Country:US
Practice Address - Phone:786-370-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty