Healthcare Provider Details

I. General information

NPI: 1134378938
Provider Name (Legal Business Name): PAIN RELIEF AND PHYSICAL REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 ROYAL GULF CIR
FORT MYERS FL
33966-7006
US

IV. Provider business mailing address

9705 COMMERCE CENTER CT STE 103
FORT MYERS FL
33908-3767
US

V. Phone/Fax

Practice location:
  • Phone: 239-226-0077
  • Fax: 239-489-0077
Mailing address:
  • Phone: 239-437-9313
  • Fax: 239-245-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH S SUSKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-226-0077