Provider Demographics
NPI:1720792567
Name:SPINE MOUNTAIN PHYSICAL THERAPY AND WELLNESS STUDIO
Entity Type:Organization
Organization Name:SPINE MOUNTAIN PHYSICAL THERAPY AND WELLNESS STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MSHA, MBA
Authorized Official - Phone:706-464-5546
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-0374
Mailing Address - Country:US
Mailing Address - Phone:762-441-0333
Mailing Address - Fax:
Practice Address - Street 1:713 GARDENVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822
Practice Address - Country:US
Practice Address - Phone:762-441-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty