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General NPI Number Information
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NPI Number | 1457574055
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE & REHABILITATION PA
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1133 SAXON BOULEVARD
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City | ORANGE CITY
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State | FL
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Zip | 32763
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Country | US
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Telephone | 386-775-7080
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Fax | 386-775-8070
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Provider Business Mailing Address
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Address Line | PO BOX 741240 PHYSICAL MEDICINE & REHABILITATION PA
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City | ORANGE CITY
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State | FL
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Zip | 32774
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Country | US
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Telephone | 386-774-5211
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Fax | 386-774-5251
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | SAMIR G CHAUDHARI
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Credential | MD
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Telephone | 386-775-7080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME95874
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License Number State |
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