Provider Demographics
NPI:1952935769
Name:PAIN CARE & PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PAIN CARE & PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORTERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:904-568-9105
Mailing Address - Street 1:2685 ALEXIA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0002
Mailing Address - Country:US
Mailing Address - Phone:904-568-9105
Mailing Address - Fax:
Practice Address - Street 1:2685 ALEXIA CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-0002
Practice Address - Country:US
Practice Address - Phone:904-568-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy