Healthcare Provider Details

I. General information

NPI: 1780915181
Provider Name (Legal Business Name): COMPREHENSIVE PAIN RELIEF INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

IV. Provider business mailing address

305 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

V. Phone/Fax

Practice location:
  • Phone: 407-556-3905
  • Fax: 407-556-3906
Mailing address:
  • Phone: 407-556-3905
  • Fax: 407-556-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT10579
License Number StateFL

VIII. Authorized Official

Name: RUTH M PANDOLPH
Title or Position: PHYSICAL THERAPIST / PRESIDENT
Credential: PT
Phone: 407-556-3905