Provider Demographics
NPI:1144496472
Name:SPINE SOLUTIONS, INC
Entity type:Organization
Organization Name:SPINE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CEAS
Authorized Official - Phone:505-424-1239
Mailing Address - Street 1:PO BOX 33286
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-3286
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:888-746-4761
Practice Address - Street 1:2538 CAMINO ENTRADA
Practice Address - Street 2:STE. 300
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4919
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty