Provider Demographics
NPI:1871247338
Name:PAIN SOLUTIONS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PAIN SOLUTIONS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:503-385-8026
Mailing Address - Street 1:1050 E FLAMINGO RD STE 228
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7435
Mailing Address - Country:US
Mailing Address - Phone:833-764-0178
Mailing Address - Fax:949-276-5401
Practice Address - Street 1:2416 13TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2546
Practice Address - Country:US
Practice Address - Phone:503-894-2826
Practice Address - Fax:949-862-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty