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General NPI Number Information
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NPI Number | 1861972002
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF EAST ALABAMA
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 267 FOB JAMES DR
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City | VALLEY
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State | AL
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Zip | 36854-5077
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Country | US
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Telephone | 718-216-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 716 BANBURY ST
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City | AUBURN
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State | AL
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Zip | 36832-3677
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Country | US
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Telephone | 718-216-8283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK MANSUR AZIZ
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Credential | MD
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Telephone | 718-216-8283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 35113
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License Number State | AL
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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 | 35113
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License Number State | AL
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