Provider Demographics
NPI:1902138142
Name:SPIRIT REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:SPIRIT REHABILITATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDECO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:702-326-0528
Mailing Address - Street 1:7451 SALVADORA PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3287
Mailing Address - Country:US
Mailing Address - Phone:702-326-0528
Mailing Address - Fax:702-562-9338
Practice Address - Street 1:7451 SALVADORA PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3287
Practice Address - Country:US
Practice Address - Phone:702-326-0528
Practice Address - Fax:702-562-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPT 1533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty