Provider Demographics
NPI:1669766556
Name:PAIN AND SPINE REHAB CENTER
Entity type:Organization
Organization Name:PAIN AND SPINE REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-860-3331
Mailing Address - Street 1:PO BOX 291785
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0785
Mailing Address - Country:US
Mailing Address - Phone:937-299-4466
Mailing Address - Fax:937-558-1138
Practice Address - Street 1:700 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3604
Practice Address - Country:US
Practice Address - Phone:513-860-3331
Practice Address - Fax:513-453-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OH2429111N00000X
OH35085482208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty