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General NPI Number Information
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NPI Number | 1811011521
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE & REHABILITATION SPECIALISTS PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 53760 GENERATIONS DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1539
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Country | US
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Telephone | 574-247-4444
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Fax | 574-243-5555
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Provider Business Mailing Address
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Address Line | 53760 GENERATIONS DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1539
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Country | US
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Telephone | 574-247-4444
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Fax | 574-243-5555
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD A GRAHAM
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Credential | MD
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Telephone | 574-247-4444
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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 | 50003415A
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License Number State | IN
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