Provider Demographics
NPI:1962028852
Name:SPINE & SPORT REHAB, INC
Entity Type:Organization
Organization Name:SPINE & SPORT REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:REMY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-228-9626
Mailing Address - Street 1:9600 SW 8TH ST STE 23B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2969
Mailing Address - Country:US
Mailing Address - Phone:305-228-9626
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST STE 23B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2969
Practice Address - Country:US
Practice Address - Phone:305-228-9626
Practice Address - Fax:305-228-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty