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Organization
SPINE TECHNOLOGY AND REHABILITATION, P.C.
Active
Organization
SPINE TECHNOLOGY AND REHABILITATION, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH D. FORTIN D.O. (PHYSICIAN/OWNER)
(260) 459-7313
Entity
Organization
Contact information
Practice address
3898 NEW VISION DR STE B, FORT WAYNE, IN 46845-1719
(260) 459-7313
(260) 436-0628
Mailing address
3898 NEW VISION DR STE B, FORT WAYNE, IN 46845-1719
(260) 459-7313
(260) 436-0628
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
2251X0800X
Orthopedic Physical Therapist
—
NULL
2251X0800X
Orthopedic Physical Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
10001306A
IN
Other
Enumeration date
11/23/2005
Last updated
06/29/2022
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