Provider Demographics
NPI:1750485751
Name:LORDEX SPINE INSTITUTE
Entity Type:Organization
Organization Name:LORDEX SPINE INSTITUTE
Other - Org Name:LORDEX SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-862-5588
Mailing Address - Street 1:928 MAR WALT DRIVE E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-862-5588
Mailing Address - Fax:850-862-6015
Practice Address - Street 1:928 MAR WALT DRIVE E
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-862-5588
Practice Address - Fax:850-862-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy