=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316646912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE PAIN MANAGEMENT AND REHABILITATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2023
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10238 SW 86TH CIR UNIT 300
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-7625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-873-1011
-----------------------------------------------------
Fax | 352-873-1017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10238 SW 86TH CIR UNIT 300
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-7625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-873-1011
-----------------------------------------------------
Fax | 352-873-1017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHAYAPATHY M JOLLU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 352-873-1011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP3300X
-----------------------------------------------------
Taxonomy Name | Pain Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------