Basic Information
| Provider Information | |||||||||
| NPI: | 1205109154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL MEDICINE ASSOCIATES LTD | ||||||||
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| OtherOrganizationName: | NATIONAL SPINE & PAIN CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 JAVIER RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039148000 | ||||||||
| FaxNumber: | 7036421876 | ||||||||
| Practice Location | |||||||||
| Address1: | 14605 POTOMAC BRANCH DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221913336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037384371 | ||||||||
| FaxNumber: | 7035806596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDLIS | ||||||||
| AuthorizedOfficialFirstName: | MAYO | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7039148000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.