Provider Demographics
NPI:1841898632
Name:SPINE STRONG PHYSICAL THERAPY AND SCOLIOSIS REHABILITATION
Entity type:Organization
Organization Name:SPINE STRONG PHYSICAL THERAPY AND SCOLIOSIS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:REID
Authorized Official - Last Name:BRIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:609-707-7955
Mailing Address - Street 1:150 SPRING ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3831
Mailing Address - Country:US
Mailing Address - Phone:609-707-7955
Mailing Address - Fax:
Practice Address - Street 1:251 DANFORTH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3705
Practice Address - Country:US
Practice Address - Phone:609-707-7955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1902192446OtherN/A