Spine Sports & Industrial Rehabilitation of Ligonier, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SPINE SPORTS & INDUSTRIAL REHABILITATION OF LIGONIER, INC.

Practice address

157 River Rd
Ligonier, IN 46767-9537

Phone

(260) 894-9909

Fax

(260) 894-9913

NPI assigned

Jun 4, 2007

Last updated

Jan 22, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Debra S Imbody, OTNPI 1235269275

Title

Owner

Phone

(260) 894-9909

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Tax ID family

Michiana Physical Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Michiana Physical Medicine

  • Specialist
  • Ligonier, IN
  • NPI 1629270343
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Debra Sue Imbody, O.T.

  • Specialist
  • Ligonier, IN
  • NPI 1235269275
  Medicare reassignment Care Compare group Authorized official
• Jeffery Lee Ciocca, PT

  • Physical Therapist
  • Kendallville, IN
  • NPI 1255340899
  Medicare reassignment Care Compare group
• Alondra De Luna Perez

  • Physical Therapy Assistant
  • Ligonier, IN
  • NPI 1619676616
  NPD
• Jolene Durham, P.T.A.

  • Specialist
  • Ligonier, IN
  • NPI 1477683415
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1376745091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8259 WICKER AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738878",
            "telephone_number": "219-365-6560",
            "fax_number": "219-365-6561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 RIVER RD",
            "city": "LIGONIER",
            "state": "IN",
            "postal_code": "467679537",
            "telephone_number": "260-894-9909",
            "fax_number": "260-894-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SPORTS & INDUSTRIAL REHABILITATION OF LIGONIER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "IMBODY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-894-9909",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert C. Stone M.D., Inc.
• Stephanie Anne Rojas, MS, OTR/L
• Jeanmarie Rorick, PT
• Nicole Savage, PHAMD
• John Steven Schroeder Camacho, PHARMD
• Stephanie Rojas LLC
• The Health and Hospital Corporation of Marion County (Avalon Village)
• Andrew M. Vorhis, N.P.
• West Noble School Corporation
• Matthew Yoder, PT

• Specialist in Ligonier, IN
• Providers in Ligonier, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.