Provider Demographics
NPI:1588823728
Name:ORLANDO PAIN & MEDICAL REHABILITATION, MW, LLC
Entity Type:Organization
Organization Name:ORLANDO PAIN & MEDICAL REHABILITATION, MW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:PORTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-927-6876
Mailing Address - Street 1:8133 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8211
Mailing Address - Country:US
Mailing Address - Phone:407-927-6876
Mailing Address - Fax:
Practice Address - Street 1:1768 PARK CENTER DR
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6200
Practice Address - Country:US
Practice Address - Phone:407-927-6876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty