Healthcare Provider Details

I. General information

NPI: 1174128748
Provider Name (Legal Business Name): FLORIDA PAIN & REHABILITATION INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 N FEDERAL HWY STE 522
FORT LAUDERDALE FL
33308-1417
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 405
MIAMI FL
33155-5506
US

V. Phone/Fax

Practice location:
  • Phone: 954-493-5048
  • Fax:
Mailing address:
  • Phone: 855-836-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SHANEKA TINCH
Title or Position: RCM MANAGER
Credential:
Phone: 469-458-9222