Provider Demographics
NPI:1073624185
Name:REHABILITATION MEDICINE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:870-934-1099
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-0717
Mailing Address - Country:US
Mailing Address - Phone:870-934-1099
Mailing Address - Fax:870-974-5953
Practice Address - Street 1:1201 FLEMING AVENUE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3144
Practice Address - Country:US
Practice Address - Phone:870-934-1099
Practice Address - Fax:870-974-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1520208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124731002Medicaid
ARMC-1520OtherARKANSAS STATE LICENSE#
AR5B460Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER