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
—
—
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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