MEDICARE: FLORIDA PAIN & REHABILITATION INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	800025838	FL

General Provider Information

NPI Number	:	1063630812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PAIN & REHABILITATION INSTITUTE INC

Provider Business Mailing Address
First Line	:	5365 W ATLANTIC AVE
Second Line	:	SUITE 504
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8172
Country	:	US
Telephone Number	:	561-241-9300
Fax Number	:	561-241-9339

Provider Business Practice Location Address
First Line	:	5948 TURKEY LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4202
Country	:	US
Telephone Number	:	407-288-8080
Fax Number	:	407-352-0104

Authorized Official
Title or Position	:	OWNER
Name	:	CHERIAN SAJAN
Credential	:	MD
Telephone Number	:	407-622-5766

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/08/2016

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