MEDICARE: ORLANDO PAIN & MED REHAB CTR INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1710088836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO PAIN & MED REHAB CTR INC

Provider Business Mailing Address
First Line	:	130 E. ALTAMONTE DRIVE
Second Line	:	SUITE 1450
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4312
Country	:	US
Telephone Number	:	407-265-2100
Fax Number	:	407-265-2872

Provider Business Practice Location Address
First Line	:	5920 RED BUG LAKE RD
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5007
Country	:	US
Telephone Number	:	407-265-2100
Fax Number	:	407-265-2872

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. PEDRO T. OLIVEROS
Credential	:	M.D.
Telephone Number	:	407-265-2100

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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