| Organization Name: | SPINE & EXTREMITY REHABILITATION CENTER OF RAYTOWN, INC. |
| NPI Number: | 1063628352 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANA E NAUMANN (OWNER-MANAGER-PHYSICAL THERAPIST) |
| Mailing Address: | 10801 E State Route 350 Raytown |
| State: | MO US |
| Postal Code: | 641382367 |
| Phone Number: | 8167375500 |
| Fax Number: | 8167375504 |
| NPI Enumeration Date: | 05/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |