Provider Demographics
NPI:1518140425
Name:HANLEY PAIN AND REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:HANLEY PAIN AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-352-1030
Mailing Address - Street 1:5979 VINELAND RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-352-1030
Practice Address - Fax:407-352-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty