Healthcare Provider Details

I. General information

NPI: 1861972002
Provider Name (Legal Business Name): PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF EAST ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 FOB JAMES DR
VALLEY AL
36854-5077
US

IV. Provider business mailing address

716 BANBURY ST
AUBURN AL
36832-3677
US

V. Phone/Fax

Practice location:
  • Phone: 718-216-8283
  • Fax:
Mailing address:
  • Phone: 718-216-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35113
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number35113
License Number StateAL

VIII. Authorized Official

Name: DR. FREDERICK MANSUR AZIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 718-216-8283