Provider Demographics
NPI:1306867890
Name:PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF EL PASO, P.A.
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF EL PASO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-598-8120
Mailing Address - Street 1:PO BOX 26217
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79926-6217
Mailing Address - Country:US
Mailing Address - Phone:915-598-8120
Mailing Address - Fax:915-598-8121
Practice Address - Street 1:1397 GEORGE DIETER DR STE D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7410
Practice Address - Country:US
Practice Address - Phone:915-598-8120
Practice Address - Fax:915-598-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6574208100000X
TX1089357261QP2000X
TXPA03679363AM0700X
TXJ6221208100000X
TXM1365208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W777Medicare PIN