Provider Demographics
NPI:1821024027
Name:SPINE & SPORTS REHABILITATION, INC
Entity Type:Organization
Organization Name:SPINE & SPORTS REHABILITATION, INC
Other - Org Name:SPINE AND SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:717-566-6000
Mailing Address - Street 1:619 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1839
Mailing Address - Country:US
Mailing Address - Phone:717-566-6000
Mailing Address - Fax:717-566-6698
Practice Address - Street 1:619 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-1839
Practice Address - Country:US
Practice Address - Phone:717-566-6000
Practice Address - Fax:717-566-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02777800OtherCAPITAL BLUE CROSS GRP#
PA046153Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER