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Provider Information for 1639102650



CENTER FOR SPINE JOINT AND NEUROMUSCULAR REHAB PC.

Organization Subpart: NO

Organization NPI: 1639102650

Calendar Last Updated: 2017-08-28

Details

Name Value
NPI 1639102650
Enumeration Date 2006-07-10
NPI Type 2- Organization
Status Active
Mailing Address 5651 FRIST BLVD STE 712
HERMITAGE, TN 37076-2061
United States

Phone: 615-872-9966 | Fax: 615-872-9967
View Map External Link
Primary Practice Address 5651 FRIST BLVD STE 712
HERMITAGE, TN 37076
United States

Phone: 615-872-9966 | Fax: 615-872-9967
View Map External Link
Authorized Official Information Name: DR. SON DIEP LE MD.
Title: OWNER/PHYSICIAN
Phone: 615-872-9966
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X SINGLE SPECIALTY GROUP
208100000X - Physical Medicine & Rehabilitation
TN 35117
Other Identifiers
Issuer State Number
MEDICAID TN 3377082
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location