Provider Demographics
NPI:1962754069
Name:THERAPEUTIC PAIN MANAGEMENT CENTER
Entity type:Organization
Organization Name:THERAPEUTIC PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAIER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCTMB
Authorized Official - Phone:215-938-1231
Mailing Address - Street 1:1320 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5830
Mailing Address - Country:US
Mailing Address - Phone:215-938-1231
Mailing Address - Fax:
Practice Address - Street 1:1320 WELSH RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5830
Practice Address - Country:US
Practice Address - Phone:215-938-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty