Healthcare Provider Details

I. General information

NPI: 1164972840
Provider Name (Legal Business Name): OHIO PAIN AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8323 E MARKET ST
WARREN OH
44484-2342
US

IV. Provider business mailing address

8323 E MARKET ST
WARREN OH
44484-2342
US

V. Phone/Fax

Practice location:
  • Phone: 330-609-5533
  • Fax:
Mailing address:
  • Phone: 330-609-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34008609
License Number StateOH

VIII. Authorized Official

Name: CHRISTOS EFTHIMIOU
Title or Position: PRESIDENT
Credential:
Phone: 330-609-5533