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Organization
SPORTS AND SPINE PHYSICAL THERAPY INC
Active
Organization
SPORTS AND SPINE PHYSICAL THERAPY INC
Active
Other names
Sportspine
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY MARIE WASSON (REGIONAL ADMINISTRATOR)
(216) 593-7070
Entity
Organization
Contact information
Practice address
3365 RICHMOND RD STE 110, BEACHWOOD, OH 44122-4171
(216) 593-7070
(216) 593-7074
Mailing address
3355 RICHMOND RD, SUITE 101A, BEACHWOOD, OH 44122-4100
(216) 593-7070
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000314395
OH BLUE CROSS/ANTHEM
OH
05
—
2452199
—
OH
01
—
DD3410
RAILROAD MEDICARE
—
Enumeration date
05/26/2006
Last updated
05/06/2019
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