Provider Demographics
NPI:1174747489
Name:PAIN & REHAB CENTER INC
Entity type:Organization
Organization Name:PAIN & REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:YUVIENCO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:239-645-6295
Mailing Address - Street 1:PO BOX 60051
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-6051
Mailing Address - Country:US
Mailing Address - Phone:239-645-6295
Mailing Address - Fax:239-549-5574
Practice Address - Street 1:21301 S TAMIAMI TRL STE 130
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2943
Practice Address - Country:US
Practice Address - Phone:239-947-5616
Practice Address - Fax:239-947-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K5100Medicare ID - Type Unspecified