| NPI | 1285182659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON RILEY VP Of Operations 904-647-5266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| 261QP3300X Clinic/Center, Pain | |
| 314000000X Skilled Nursing Facility (Licence: FL PA9105187) | |
| 314000000X Skilled Nursing Facility (Licence: FL me117856) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2021-12-13 |