Provider Demographics
NPI:1134378938
Name:PAIN RELIEF AND PHYSICAL REHAB INC
Entity type:Organization
Organization Name:PAIN RELIEF AND PHYSICAL REHAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-226-0077
Mailing Address - Street 1:9705 COMMERCE CENTER CT STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3767
Mailing Address - Country:US
Mailing Address - Phone:239-437-9313
Mailing Address - Fax:239-245-8060
Practice Address - Street 1:4977 ROYAL GULF CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-7006
Practice Address - Country:US
Practice Address - Phone:239-226-0077
Practice Address - Fax:239-489-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17033OtherBCBS
FL2658666-00Medicaid
FL17033XOtherMEDICARE
FL17033OtherBCBS