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General NPI Number Information
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NPI Number | 1194911321
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Entity Type | Organization
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Legal Business Name | PAIN & PHYSICAL MEDICINE CONSULTANTS LLC
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 3501 HEALTH CENTER BLVD SUITE 1300
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-8127
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Country | US
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Telephone | 239-390-9778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 368375
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City | BONITA SPRINGS
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State | FL
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Zip | 34136-8375
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT O'LEARY
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Credential | D.O.
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Telephone | 239-390-9778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS9857
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License Number State | FL
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