=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760619811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLANDO PAIN AND REHAB CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2009
-----------------------------------------------------
Last Update Date | 06/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6005 SILVER STAR RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808-8203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-299-5003
-----------------------------------------------------
Fax | 407-299-1471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6005 SILVER STAR RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808-8203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-299-5003
-----------------------------------------------------
Fax | 407-299-1471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JUANITO ESTRADA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-299-5003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------