Provider Demographics
NPI:1720378540
Name:LEESBURG PAIN & REHAB, INC
Entity Type:Organization
Organization Name:LEESBURG PAIN & REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-608-9248
Mailing Address - Street 1:32749 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3901
Mailing Address - Country:US
Mailing Address - Phone:305-608-9248
Mailing Address - Fax:
Practice Address - Street 1:32749 RADIO RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3901
Practice Address - Country:US
Practice Address - Phone:305-608-9248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty