Provider Demographics
NPI:1922631845
Name:ORTHO SPINE AND PAIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ORTHO SPINE AND PAIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:336-815-8828
Mailing Address - Street 1:4139 WEDGE DR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9709
Mailing Address - Country:US
Mailing Address - Phone:336-815-8828
Mailing Address - Fax:336-815-1546
Practice Address - Street 1:4139 WEDGE DR
Practice Address - Street 2:
Practice Address - City:PFAFFTOWN
Practice Address - State:NC
Practice Address - Zip Code:27040-9709
Practice Address - Country:US
Practice Address - Phone:336-815-8828
Practice Address - Fax:336-815-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy