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General NPI Number Information
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NPI Number | 1518039833
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Entity Type | Organization
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Legal Business Name | FLOURTOWN PAIN EVALUATION AND TREATMENT CENTER
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1811 BETHLEHEM PIKE SUITE 221
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City | FLOURTOWN
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State | PA
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Zip | 19031
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Country | US
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Telephone | 215-233-1223
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Fax | 215-233-1141
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Provider Business Mailing Address
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Address Line | 1811 BETHLEHEM PIKE SUITE 221
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City | FLOURTOWN
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State | PA
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Zip | 19031
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Country | US
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Telephone | 215-233-1223
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Fax | 215-233-1141
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KENNETH L IZZO
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Credential | MD
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Telephone | 215-233-1223
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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 | MD017101
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License Number State | PA
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