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General NPI Number Information
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NPI Number | 1972777001
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Entity Type | Organization
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Legal Business Name | PHYSIATRY AND REHABILITATION ASSOCIATES LLC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 08/18/2024
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Provider Practice Location Address
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Address Line | 113 BLARNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29223-6244
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Country | US
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Telephone | 803-788-2225
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Fax | 803-788-2120
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Provider Business Mailing Address
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Address Line | 113 BLARNEY DR
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City | COLUMBIA
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State | SC
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Zip | 29223-6244
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Country | US
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Telephone | 803-788-2225
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Fax | 803-788-2120
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Authorized Official
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Title or Position | CEO
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Name | DR. USAMA A GABR
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Credential | M.D.
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Telephone | 803-788-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28228
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License Number State | SC
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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 | 28228
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35084155
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35084155
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301102325
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License Number State | MI
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