Pain to Wellness Healthcare Corporation

Contacts

Phone	+1 301-512-6695

Authorized person

Name	TONJA WILLIAMS
Role	BILLING MANAGER
Phone	2566565789

Taxonomy

Taxonomy Code	208100000X - Physical Medicine & Rehabilitation Physician
License Number	MD.28695
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	INDIVIDUAL NPI
Number	1518953967
State	AL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2024-07-30
Name of individual signing	HELEN POWELL-STODDART, MD

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2023-07-24
Name of individual signing	HELEN POWELL-STODDART, MD
Role	Employer/plan sponsor
Date	2023-07-19
Name of individual signing	JOHN STODDART

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2022-09-26
Name of individual signing	HELEN POWELL-STODDART, MD
Role	Employer/plan sponsor
Date	2022-08-26
Name of individual signing	JOHN STODDART

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2021-09-02
Name of individual signing	HELEN POWELL-STODDART, MD
Role	Employer/plan sponsor
Date	2021-05-19
Name of individual signing	JOHN STODDART

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2020-07-22
Name of individual signing	HELEN POWELL-STODDART, MD
Role	Employer/plan sponsor
Date	2020-07-22
Name of individual signing	JOHN STODDART

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2019-07-16
Name of individual signing	HELEN POWELL-STODDART, MD
Role	Employer/plan sponsor
Date	2019-07-16
Name of individual signing	JOHN STODDART

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2018-07-06
Name of individual signing	HELEN POWELL-STODDART, MD
Role	Employer/plan sponsor
Date	2018-07-09
Name of individual signing	JOHN STODDART

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-03-15
Business code	621111
Sponsor’s telephone number	3015126695
Plan sponsor’s address	235 PORTAL LANE SUITE B, MADISON, AL, 35758

Signature of

Role	Plan administrator
Date	2017-08-30
Name of individual signing	DR. HELEN P. STODDART