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General NPI Number Information
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NPI Number | 1619084001
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Entity Type | Organization
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Legal Business Name | PAIN SPECIALIST OF ORLANDO, INC.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 6005 SILVER STAR RD
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City | ORLANDO
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State | FL
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Zip | 32808-8201
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Country | US
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Telephone | 407-299-5003
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Fax | 407-299-1471
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Provider Business Mailing Address
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Address Line | 6005 SILVER STAR RD
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City | ORLANDO
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State | FL
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Zip | 32808-8201
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Country | US
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Telephone | 407-299-5003
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Fax | 407-299-1471
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUANITO T. ESTRADA
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Credential |
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Telephone | 407-299-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | HCC5335
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License Number State | FL
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