Healthcare Provider Details

I. General information

NPI: 1912045105
Provider Name (Legal Business Name): UNITED MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 GREENSBORO DR SUITE 800
MC LEAN VA
22102-3605
US

IV. Provider business mailing address

2221 ROSECRANS AVE SUITE 111
EL SEGUNDO CA
90245-4931
US

V. Phone/Fax

Practice location:
  • Phone: 310-643-1640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGG M KELBAUGH
Title or Position: PRESIDENT
Credential:
Phone: 310-643-1860