Provider Demographics
NPI:1437331766
Name:PAIN RELIEF CENTER
Entity Type:Organization
Organization Name:PAIN RELIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MYOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRIEPENSTROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-529-8378
Mailing Address - Street 1:12198 N CR 600 E
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:IN
Mailing Address - Zip Code:47550-7267
Mailing Address - Country:US
Mailing Address - Phone:812-529-8378
Mailing Address - Fax:812-529-8360
Practice Address - Street 1:12198 N CR 600 E
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:IN
Practice Address - Zip Code:47550
Practice Address - Country:US
Practice Address - Phone:812-529-8378
Practice Address - Fax:812-529-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ000034153173C00000X, 225700000X, 225XN1300X
225700000X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ000034153OtherIN LICENSE # IN000034153