Provider Demographics
NPI:1982765228
Name:PHYSICAL MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES, LLC
Other - Org Name:THE CENTER FOR INTEGRATIVE BODY THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STORCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-237-7000
Mailing Address - Street 1:5225 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 601
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2014
Mailing Address - Country:US
Mailing Address - Phone:202-364-6016
Mailing Address - Fax:202-237-2583
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 601
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2014
Practice Address - Country:US
Practice Address - Phone:202-364-6016
Practice Address - Fax:202-237-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH12977111N00000X
DCPT2445225100000X
DCPT870634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00478Medicare ID - Type UnspecifiedPHYSICAL THERAPY