Organization
BRAIN AND SPINE WORK ASSESSMENT AND THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON SAMUELIAN (CEO)
(850) 747-0400
Entity
Organization
Contact information
Practice address
2101 NORTHSIDE DR, SUITE 502, PANAMA CITY, FL 32405-3685
(850) 913-7040
(850) 913-0290
Mailing address
2101 NORTHSIDE DR, SUITE 502, PANAMA CITY, FL 32405-3685
(850) 913-7040
(850) 913-0290
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT4387
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y924S
BCBS SUPER Y GROUP #
FL
Enumeration date
05/21/2007
Last updated
08/22/2020
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