Provider Demographics
NPI:1023349180
Name:PAIN REHABILITATION LLC
Entity type:Organization
Organization Name:PAIN REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRAUSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-342-4003
Mailing Address - Street 1:3162 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3170
Mailing Address - Country:US
Mailing Address - Phone:812-342-4003
Mailing Address - Fax:812-342-4003
Practice Address - Street 1:3162 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3170
Practice Address - Country:US
Practice Address - Phone:812-342-4003
Practice Address - Fax:812-342-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty