Provider Demographics
NPI:1962817957
Name:SPINAL REHAB AND HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SPINAL REHAB AND HEALTHCARE, LLC
Other - Org Name:SPINAL REHAB AND HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNERY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-778-0077
Mailing Address - Street 1:186 CANNON BRIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-4700
Mailing Address - Country:US
Mailing Address - Phone:706-778-0077
Mailing Address - Fax:
Practice Address - Street 1:186 CANNON BRIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-4700
Practice Address - Country:US
Practice Address - Phone:706-778-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty