Provider Demographics
NPI:1558320267
Name:PHYSICAL MEDICINE & REHABILITATION OF RICHMOND INC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE & REHABILITATION OF RICHMOND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANMOHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHOKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-530-0160
Mailing Address - Street 1:1401 JOHNSTON WILLIS DRIVE
Mailing Address - Street 2:5 E IN PT REHAB
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4722
Mailing Address - Country:US
Mailing Address - Phone:804-530-0160
Mailing Address - Fax:804-378-2248
Practice Address - Street 1:1401 JOHNSTON WILLIS DRIVE
Practice Address - Street 2:5 E IN PT REHAB
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4722
Practice Address - Country:US
Practice Address - Phone:804-530-0160
Practice Address - Fax:804-378-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08460OtherMEDICARE GROUP NUMBER