Provider Demographics
NPI:1205153756
Name:SPINE & EXTREMITY REHABILATATION
Entity type:Organization
Organization Name:SPINE & EXTREMITY REHABILATATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LUBET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-485-5959
Mailing Address - Street 1:4465 NW ALSACE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8338
Mailing Address - Country:US
Mailing Address - Phone:772-468-4999
Mailing Address - Fax:772-464-2447
Practice Address - Street 1:1107 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4048
Practice Address - Country:US
Practice Address - Phone:772-464-2200
Practice Address - Fax:772-464-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty