Provider Demographics
NPI:1760256390
Name:IRONSPINE MOVEMENT
Entity Type:Organization
Organization Name:IRONSPINE MOVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-577-5405
Mailing Address - Street 1:2003 PEPPERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-3011
Mailing Address - Country:US
Mailing Address - Phone:504-577-5405
Mailing Address - Fax:
Practice Address - Street 1:2003 PEPPERS FERRY RD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-3011
Practice Address - Country:US
Practice Address - Phone:504-577-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty