Provider Demographics
NPI:1255723649
Name:PHYSICAL MEDICINE CENTER LLC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-372-3772
Mailing Address - Street 1:2686 MONROEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2302
Mailing Address - Country:US
Mailing Address - Phone:412-372-3772
Mailing Address - Fax:412-372-3688
Practice Address - Street 1:2686 MONROEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2302
Practice Address - Country:US
Practice Address - Phone:412-372-3772
Practice Address - Fax:412-372-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty