Provider Demographics
NPI:1891733457
Name:NORTHEAST SPINE & REHAB., LLC
Entity Type:Organization
Organization Name:NORTHEAST SPINE & REHAB., LLC
Other - Org Name:NORTHEAST PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RONELL
Authorized Official - Middle Name:RONLEY
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-368-1192
Mailing Address - Street 1:5520 PARK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-368-1192
Mailing Address - Fax:203-371-0358
Practice Address - Street 1:5520 PARK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-368-1192
Practice Address - Fax:203-371-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy