MEDICARE: PHYSICIANS DIAGNOSTIC AND REHABIITATION SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1255560868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS DIAGNOSTIC AND REHABIITATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	4651 N STATE ROAD 7 STE 9
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4378
Country	:	US
Telephone Number	:	954-753-4248
Fax Number	:	954-255-7990

Provider Business Practice Location Address
First Line	:	4651 N STATE ROAD 7 STE 9
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4378
Country	:	US
Telephone Number	:	954-753-4248
Fax Number	:	954-255-7990

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. HOWARD NEWMAN
Credential	:	D,C,
Telephone Number	:	954-753-4248

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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