Provider Demographics
NPI:1376946491
Name:ADVANCED REHABILITAION & PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:ADVANCED REHABILITAION & PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ABDU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:865-661-2787
Mailing Address - Street 1:601 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-2702
Mailing Address - Country:US
Mailing Address - Phone:865-661-2787
Mailing Address - Fax:
Practice Address - Street 1:601 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-2702
Practice Address - Country:US
Practice Address - Phone:865-661-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4178261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy