Healthcare Provider Details

I. General information

NPI: 1407809783
Provider Name (Legal Business Name): PHYSICAL MEDICINE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR DEPT OF PMR
DAYTON OH
45406-1891
US

IV. Provider business mailing address

PO BOX 78000 DEPT 781272
DETROIT MI
48278-1272
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-7771
  • Fax: 937-277-3771
Mailing address:
  • Phone: 937-298-5536
  • Fax: 937-298-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: PANI S AKUTHOTA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 937-277-7771