# SPINE TECHNOLOGY AND REHABILITATION, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245213263
- **Authorized official:** JOSEPH D. FORTIN D.O. (PHYSICIAN/OWNER)
- **Authorized official phone:** (260) 459-7313

## Contact information

- **Practice address:** 3898 NEW VISION DR STE B, FORT WAYNE, IN 46845-1719
- **Practice address phone:** (260) 459-7313
- **Practice address fax:** (260) 436-0628
- **Mailing address:** 3898 NEW VISION DR STE B, FORT WAYNE, IN 46845-1719
- **Mailing address phone:** (260) 459-7313
- **Mailing address fax:** (260) 436-0628

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 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