Provider Demographics
NPI:1902160898
Name:ACUTE SPINE THERAPY & REHAB, LLC
Entity Type:Organization
Organization Name:ACUTE SPINE THERAPY & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-595-1838
Mailing Address - Street 1:20 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3581
Mailing Address - Country:US
Mailing Address - Phone:301-977-0640
Mailing Address - Fax:301-977-0643
Practice Address - Street 1:20 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3581
Practice Address - Country:US
Practice Address - Phone:301-977-0640
Practice Address - Fax:301-977-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty