=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619347838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL MEDICINE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2015
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6710 OXON HILL RD STE 550
-----------------------------------------------------
City | OXON HILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20745-1117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-914-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4960 SW 72ND AVE STE 405
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-5506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-458-9222
-----------------------------------------------------
Fax | 540-918-7202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCM MANAGER
-----------------------------------------------------
Name | SHANEKA TINCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-458-9222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | C0005875
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------