Provider Demographics
NPI:1477810166
Name:CENTER FOR REHABILITATION PAIN MANAGEMENT AND WELLNESS PA
Entity Type:Organization
Organization Name:CENTER FOR REHABILITATION PAIN MANAGEMENT AND WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-383-4263
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:122 SLADE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4915
Practice Address - Country:US
Practice Address - Phone:410-383-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR REHABILITATION PAIN MANAGEMENT AND WELLNESS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-18
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site