Healthcare Provider Details

I. General information

NPI: 1437331766
Provider Name (Legal Business Name): PAIN RELIEF CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12198 N CR 600 E
LAMAR IN
47550
US

IV. Provider business mailing address

12198 N CR 600 E
LAMAR IN
47550-7267
US

V. Phone/Fax

Practice location:
  • Phone: 812-529-8378
  • Fax: 812-529-8360
Mailing address:
  • Phone: 812-529-8378
  • Fax: 812-529-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberIN000034153
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberIN000034153
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberIN000034153
License Number StateIN

VIII. Authorized Official

Name: MRS. KATHY P GRIEPENSTROH
Title or Position: OWNER MYOTHERAPIST
Credential:
Phone: 812-529-8378