Healthcare Provider Details

I. General information

NPI: 1003352592
Provider Name (Legal Business Name): PAINALGIA RELIEF CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MOHAWK RD
CLERMONT FL
34715
US

IV. Provider business mailing address

PO BOX 720696
ORLANDO FL
32872-0696
US

V. Phone/Fax

Practice location:
  • Phone: 407-531-8069
  • Fax: 407-386-3212
Mailing address:
  • Phone: 407-531-8069
  • Fax: 407-386-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL THIERRY SAINT-ELIE
Title or Position: PHYSICIAN
Credential: MD
Phone: 407-531-8069