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General NPI Number Information
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NPI Number | 1477546935
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE ASSOCIATES SC
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 429 N KIRK RD STE 103
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City | GENEVA
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State | IL
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Zip | 60134-1667
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Country | US
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Telephone | 630-605-6323
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Fax | 630-428-4305
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Provider Business Mailing Address
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Address Line | 24W500 MAPLE AVE #105
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City | NAPERVILLE
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State | IL
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Zip | 60540-6055
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Country | US
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Telephone | 630-428-4300
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Fax | 630-428-4305
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Authorized Official
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Title or Position | OM
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Name | TARYN HALL
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Credential |
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Telephone | 630-450-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 042617710
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 042617710
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042617710
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License Number State | IL
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