Provider Demographics
NPI:1356112528
Name:TRAUMA PAIN & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:TRAUMA PAIN & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BOLLERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPS, CTCP
Authorized Official - Phone:267-951-4493
Mailing Address - Street 1:119 SOUTH EASTON RD.
Mailing Address - Street 2:LOWER LEVEL SUITE 104
Mailing Address - City:GLENSIDE, PA
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4525
Mailing Address - Country:US
Mailing Address - Phone:267-858-6730
Mailing Address - Fax:267-287-8047
Practice Address - Street 1:119 SOUTH EASTON RD.
Practice Address - Street 2:LOWER LEVEL SUITE 104
Practice Address - City:GLENSIDE, PA
Practice Address - State:PA
Practice Address - Zip Code:19038-4525
Practice Address - Country:US
Practice Address - Phone:267-858-6730
Practice Address - Fax:267-287-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty