Healthcare Provider Details

I. General information

NPI: 1316646912
Provider Name (Legal Business Name): COMPREHENSIVE PAIN MANAGEMENT AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 SW 86TH CIR UNIT 300
OCALA FL
34481-7625
US

IV. Provider business mailing address

10238 SW 86TH CIR UNIT 300
OCALA FL
34481-7625
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-1011
  • Fax: 352-873-1017
Mailing address:
  • Phone: 352-873-1011
  • Fax: 352-873-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHAYAPATHY M JOLLU
Title or Position: OWNER
Credential: MD
Phone: 352-873-1011