Provider Demographics
NPI:1518422054
Name:PM&R OF YUMA PLLC
Entity Type:Organization
Organization Name:PM&R OF YUMA PLLC
Other - Org Name:PM&R OF YUMA PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-955-0002
Mailing Address - Street 1:1773 W 24TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6230
Mailing Address - Country:US
Mailing Address - Phone:928-955-0002
Mailing Address - Fax:844-260-2871
Practice Address - Street 1:1773 W 24TH ST STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6230
Practice Address - Country:US
Practice Address - Phone:928-955-0002
Practice Address - Fax:844-260-2871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PM&R OF YUMA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-08
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)