Provider Demographics
NPI:1558506030
Name:THE PAIN TREATMENT AND WELLNESS CENTER
Entity Type:Organization
Organization Name:THE PAIN TREATMENT AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMTPT
Authorized Official - Phone:724-853-2353
Mailing Address - Street 1:245 HUMPHREY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4580
Mailing Address - Country:US
Mailing Address - Phone:724-853-2353
Mailing Address - Fax:724-853-2354
Practice Address - Street 1:245 HUMPHREY RD STE 2
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4580
Practice Address - Country:US
Practice Address - Phone:724-853-2353
Practice Address - Fax:724-853-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002346L111N00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty