Basic Information
| Provider Information | |||||||||
| NPI: | 1467485771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL MEDICINE ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 1010 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142673300 | ||||||||
| FaxNumber: | 6142673323 | ||||||||
| Practice Location | |||||||||
| Address1: | 3555 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 1010 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142673300 | ||||||||
| FaxNumber: | 6142673323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEADOWS | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6145664907 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
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 | 0451729 | 05 | OH | MEDICAID |