Provider Demographics
NPI:1912950825
Name:REHABILITATION AND PAIN SPECIALISTS
Entity Type:Organization
Organization Name:REHABILITATION AND PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NARDOZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-6480
Mailing Address - Street 1:107 GAMMA DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2982
Mailing Address - Country:US
Mailing Address - Phone:412-963-6480
Mailing Address - Fax:412-963-6820
Practice Address - Street 1:107 GAMMA DR
Practice Address - Street 2:SUITE 220
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2982
Practice Address - Country:US
Practice Address - Phone:412-963-6480
Practice Address - Fax:412-963-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101166032 0001Medicaid
PA101166032 0001Medicaid