Basic Information
| Provider Information | |||||||||
| NPI: | 1356374599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 489 AGNES ST STE 112-132 | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786022156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123605266 | ||||||||
| FaxNumber: | 5123605277 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 E 32ND ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787052703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125447111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOLNAR | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5123605266 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0940686-01 | 05 | TX | MEDICAID |