MEDICARE: UNITED MEDICAL MANAGEMENT, INC.

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1912045105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED MEDICAL MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	2221 ROSECRANS AVE
Second Line	:	SUITE 111
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-4931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 GREENSBORO DR
Second Line	:	SUITE 800
City	:	MC LEAN
State	:	VA
Zip	:	22102-3605
Country	:	US
Telephone Number	:	310-643-1640
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGG M KELBAUGH
Credential	:
Telephone Number	:	310-643-1860

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/22/2020

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