# SPORTS AND SPINE PHYSICAL THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sportspine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619923026
- **Authorized official:** TIFFANY MARIE WASSON (REGIONAL ADMINISTRATOR)
- **Authorized official phone:** (216) 593-7070

## Contact information

- **Practice address:** 3365 RICHMOND RD STE 110, BEACHWOOD, OH 44122-4171
- **Practice address phone:** (216) 593-7070
- **Practice address fax:** (216) 593-7074
- **Mailing address:** 3355 RICHMOND RD, SUITE 101A, BEACHWOOD, OH 44122-4100
- **Mailing address phone:** (216) 593-7070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 05/06/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000314395 | OH BLUE CROSS/ANTHEM | OH |
| 05 | — | 2452199 | — | OH |
| 01 | — | DD3410 | RAILROAD MEDICARE | — |