Provider Demographics
NPI:1740406164
Name:ORTHO -SPINE REHABILIATION CENTER , INC
Entity Type:Organization
Organization Name:ORTHO -SPINE REHABILIATION CENTER , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-389-8882
Mailing Address - Street 1:7211 SAWMILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5008
Mailing Address - Country:US
Mailing Address - Phone:614-793-8817
Mailing Address - Fax:
Practice Address - Street 1:7211 SAWMILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-5008
Practice Address - Country:US
Practice Address - Phone:614-793-8817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080788208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333951Medicaid
OHCH4073731Medicare ID - Type Unspecified