Healthcare Provider Details

I. General information

NPI: 1821342619
Provider Name (Legal Business Name): PAIN RELIEF PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W 5TH ST
EUREKA MO
63025-1109
US

IV. Provider business mailing address

1585 WOODLAKE DR STE 214
CHESTERFIELD MO
63017-5740
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-9310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005031148
License Number StateMO

VIII. Authorized Official

Name: CANDACE M MANGRUM
Title or Position: BILLING
Credential:
Phone: 314-275-8737