1134584741 NPI number — SPORTS & SPINE MEDICAL REHABILITATION PLLC

Table of content: MRS. LISA ELIZABETH DAVIDSON PT (NPI 1477627461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134584741 NPI number — SPORTS & SPINE MEDICAL REHABILITATION PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS & SPINE MEDICAL REHABILITATION PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134584741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9239 BAYWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32819-4087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-967-9366
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9239 BAYWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32819-4087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-967-9366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSAIN
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND FOUNDER
Authorized Official Telephone Number:
310-967-9366

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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