| Organization Name: | MONTGOMERY VILLAGE PAIN AND REHABILITATION CENTER LLC |
| NPI Number: | 1053655639 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICK ESKEW (CFO) |
| Mailing Address: | 19211 Montgomery Village Ave Suite B-12 Montgomery Village |
| State: | MD US |
| Postal Code: | 208865028 |
| Phone Number: | 2404775452 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2012 |
| NPI Last Update Date: | 02/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |