Provider Demographics
NPI:1841471976
Name:SPINE AND SPORTS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SPINE AND SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:NESTOR III
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, COMT
Authorized Official - Phone:617-970-7881
Mailing Address - Street 1:150 RUMFORD AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2150
Mailing Address - Country:US
Mailing Address - Phone:617-970-7881
Mailing Address - Fax:
Practice Address - Street 1:150 RUMFORD AVE APT 404
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2150
Practice Address - Country:US
Practice Address - Phone:617-970-7881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10934261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy