| Organization Name: | SPORT & SPINE CLINIC LP |
| NPI Number: | 1043252695 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD BINSTEIN (VP, AUTHORIZED OFFICIAL) |
| Mailing Address: | 10524 George Ave Suite 2 Auburndale |
| State: | WI US |
| Postal Code: | 544129677 |
| Phone Number: | 7156523470 |
| Fax Number: | 7156523473 |
| NPI Enumeration Date: | 06/11/2006 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |