Provider Demographics
NPI:1265799605
Name:PAIN SOLUTIONS THERAPEUTIC & SPORTS MASSAGE
Entity type:Organization
Organization Name:PAIN SOLUTIONS THERAPEUTIC & SPORTS MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER/ MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:NYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-226-2976
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0983
Mailing Address - Country:US
Mailing Address - Phone:352-226-2976
Mailing Address - Fax:
Practice Address - Street 1:25355 W NEWBERRY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4253
Practice Address - Country:US
Practice Address - Phone:352-226-2976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912125931OtherINDIVIDUAL NPI