Provider Demographics
NPI:1649234923
Name:PAIN RELIEF AND PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PAIN RELIEF AND PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:O'HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT SCS
Authorized Official - Phone:610-789-9887
Mailing Address - Street 1:316 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5434
Mailing Address - Country:US
Mailing Address - Phone:610-789-1599
Mailing Address - Fax:
Practice Address - Street 1:57 W EAGLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2234
Practice Address - Country:US
Practice Address - Phone:610-789-9887
Practice Address - Fax:610-789-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-002907-E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA445391000OtherKEYSTONE
PACK5209OtherRAILROAD MEDICARE
PAI68311OtherAMERIHEALTH GRP #
PA1017072OtherAETNA GROUP PROV. #
PA000968311OtherBS/BC GROUP #
PA0214300OtherORTHONET GRP #
PA0445391000OtherPERSONALCHOICE PROVIDER#
PAI68311OtherAMERIHEALTH GRP #