Provider Demographics
NPI:1265912448
Name:QUALITY PAIN REHAB LLC
Entity type:Organization
Organization Name:QUALITY PAIN REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANALYN
Authorized Official - Middle Name:ESCOBER
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:239-572-4779
Mailing Address - Street 1:1065 DIANA AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4845
Mailing Address - Country:US
Mailing Address - Phone:239-572-4779
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE FRANK RD STE A100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-572-4779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1144536756OtherMEDICARE B