# SPINE PAIN REHAB, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114255114
- **Authorized official:** JO BOWEN (BILLING MANAGER)
- **Authorized official phone:** (609) 261-5755

## Contact information

- **Practice address:** 701 WHITE HORSE RD, SUITE 1, VOORHEES, NJ 08043-2494
- **Practice address phone:** (609) 581-2700
- **Practice address fax:** (609) 261-7199
- **Mailing address:** PO BOX 154, MARLTON, NJ 08053-0154
- **Mailing address phone:** (609) 261-5755
- **Mailing address fax:** (609) 261-7199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 25MA06687200 | NJ | Yes |

## Other

- **Enumeration date:** 12/02/2009
- **Last updated:** 12/02/2009