Healthcare Provider Details

I. General information

NPI: 1033232103
Provider Name (Legal Business Name): PHYSICAL MEDICINE ASSOCIATES OF N.W. OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 W MARKET ST SUITE 106
LIMA OH
45801-4653
US

IV. Provider business mailing address

658 W MARKET ST SUITE 106
LIMA OH
45801-4653
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-5434
  • Fax: 419-228-4620
Mailing address:
  • Phone: 419-228-5434
  • Fax: 419-228-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SUSAN L HUBBELL
Title or Position: PRESIDENT
Credential: MD
Phone: 419-228-5434