# WESTERN RESERVE PROFESSIONAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Spine & Pain Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699986620
- **Authorized official:** RACHELLE ANN LIGHT (OFFICE COORDINATOR)
- **Authorized official phone:** (330) 677-3628

## Contact information

- **Practice address:** 307 WEST MAIN STREET, SUITE C, KENT, OH 44240-2400
- **Practice address phone:** (330) 677-3628
- **Practice address fax:** (330) 677-4931
- **Mailing address:** PO BOX 715479, COLUMBUS, OH 43271-5479
- **Mailing address phone:** (330) 677-3628
- **Mailing address fax:** (330) 677-4931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NX0800X | Orthopedic Chiropractor | — | NULL | — |
| 111NX0800X | Orthopedic Chiropractor | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 05/24/2007
- **Last updated:** 01/15/2014