Provider Demographics
NPI:1407809783
Name:PHYSICAL MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PANI
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKUTHOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-277-7771
Mailing Address - Street 1:PO BOX 78000
Mailing Address - Street 2:DEPT 781272
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1272
Mailing Address - Country:US
Mailing Address - Phone:937-298-5536
Mailing Address - Fax:937-298-5596
Practice Address - Street 1:2222 PHILADELPHIA DR
Practice Address - Street 2:DEPT OF PMR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1891
Practice Address - Country:US
Practice Address - Phone:937-277-7771
Practice Address - Fax:937-277-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703564Medicaid
OH9926781Medicare PIN
OHCE0488Medicare PIN