Provider Demographics
NPI:1699072918
Name:PAIN RELIEF TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:PAIN RELIEF TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYBIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:703-856-2553
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20172-0544
Mailing Address - Country:US
Mailing Address - Phone:703-856-2553
Mailing Address - Fax:703-404-2763
Practice Address - Street 1:3022 JAVIER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4645
Practice Address - Country:US
Practice Address - Phone:703-856-2553
Practice Address - Fax:703-404-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty