Provider Demographics
NPI:1972673077
Name:THE PAIN & REHAB INSTITUTE, PA
Entity Type:Organization
Organization Name:THE PAIN & REHAB INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-663-3777
Mailing Address - Street 1:128 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8000
Mailing Address - Country:US
Mailing Address - Phone:704-663-3777
Mailing Address - Fax:704-664-6615
Practice Address - Street 1:116 MORLAKE DR STE 204
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9525
Practice Address - Country:US
Practice Address - Phone:704-663-3777
Practice Address - Fax:704-664-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty