Provider Demographics
NPI:1457678385
Name:LSI ASPEN BACK AND BODY, LLC
Entity Type:Organization
Organization Name:LSI ASPEN BACK AND BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-289-9613
Mailing Address - Street 1:3001 N ROCKY POINT DR E STE 360
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5876
Mailing Address - Country:US
Mailing Address - Phone:813-289-9613
Mailing Address - Fax:813-418-4144
Practice Address - Street 1:315 E DEAN ST
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1807
Practice Address - Country:US
Practice Address - Phone:970-920-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty