MEDICARE: PHYSICAL MEDICINE ASSOCIATES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician		VA

General Provider Information

NPI Number	:	1205109154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL MEDICINE ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	4960 SW 72ND AVE STE 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5506
Country	:	US
Telephone Number	:	469-458-9222
Fax Number	:	540-918-7202

Provider Business Practice Location Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:	SUITE 100
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-738-4371
Fax Number	:	703-580-6596

Authorized Official
Title or Position	:	RCM MANAGER
Name	:	SHANEKA TINCH
Credential	:
Telephone Number	:	469-458-9222

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	12/08/2025

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