Provider Demographics
NPI:1679871321
Name:SOUTHERN PAIN AND REHAB, LLC
Entity Type:Organization
Organization Name:SOUTHERN PAIN AND REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-937-8759
Mailing Address - Street 1:7802 DELTA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-8167
Mailing Address - Country:US
Mailing Address - Phone:251-626-0901
Mailing Address - Fax:
Practice Address - Street 1:26211 EQUITY DR
Practice Address - Street 2:SUITE A
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-6189
Practice Address - Country:US
Practice Address - Phone:251-626-0901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty