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General NPI Number Information
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NPI Number | 1982069555
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Entity Type | Organization
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Legal Business Name | PAIN RECOVERY CENTER LLC
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 12390 PLACIDA RD
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City | PLACIDA
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State | FL
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Zip | 33946-2114
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Country | US
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Telephone | 814-769-1926
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Fax | 774-209-4546
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Provider Business Mailing Address
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Address Line | 12390 PLACIDA RD
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City | PLACIDA
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State | FL
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Zip | 33946-2114
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Country | US
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Telephone | 814-769-1926
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Fax | 774-209-4546
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GREGORY FAMIGLIO
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Credential |
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Telephone | 814-769-1926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MD042726L
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License Number State | PA
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