Organization · NPI-2

Brevard Orthopaedic Spine & Pain Clinic INC

Physical Therapist · Melbourne, FL

NPI number1003100504

StatusActive

Last updated in NPPESJul 15, 2021

Details

NPI: 1003100504
Entity type: Organization (NPI-2)
Legal business name: Brevard Orthopaedic Spine & Pain Clinic INC
Organization subpart: Yes
Enumeration date: Jun 2, 2011
Certification date: Jul 15, 2021
Last updated: Jul 15, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
225100000X	Physical Therapist	–	–	Yes
111N00000X	Chiropractor	–	–
225700000X	Massage Therapist	–	–

Other names

The Back Center (Doing Business As)

Practice location

2222 S Harbor City Blvd
Suite 530
Melbourne, FL 32901-5594

Phone 321-723-7716 · Fax 321-723-0604

Mailing address

2222 S Harbor City Blvd
Suite 610
Melbourne, FL 32901-5594

Phone 321-723-7716 · Fax 321-723-0604

Authorized official

Katrina Lopez
Credentialing
3215411537

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