Organization
SPINE PAIN REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JO BOWEN (BILLING MANAGER)
(609) 261-5755
Entity
Organization
Contact information
Practice address
701 WHITE HORSE RD, SUITE 1, VOORHEES, NJ 08043-2494
(609) 581-2700
(609) 261-7199
Mailing address
PO BOX 154, MARLTON, NJ 08053-0154
(609) 261-5755
(609) 261-7199
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
25MA06687200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA06687200
NJ LICENSE
NJ
Enumeration date
12/02/2009
Last updated
12/02/2009
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