Healthcare Provider Details

I. General information

NPI: 1396235099
Provider Name (Legal Business Name): PAIN CENTER OF VIRGINIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 WEST PLAZA DR
WINCHESTER VA
22601-6365
US

IV. Provider business mailing address

1839 PLAZA DR
WINCHESTER VA
22601-6365
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-6165
  • Fax: 540-486-4166
Mailing address:
  • Phone: 304-263-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LARRICK
Title or Position: PRACTICE COORDINATOR
Credential:
Phone: 304-263-6165