1205109154 NPI number — PHYSICAL MEDICINE ASSOCIATES LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205109154 NPI number — PHYSICAL MEDICINE ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL MEDICINE ASSOCIATES LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205109154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 SW 72ND AVE STE 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-5506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-458-9222
Provider Business Mailing Address Fax Number:
540-918-7202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14605 POTOMAC BRANCH DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22191-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-738-4371
Provider Business Practice Location Address Fax Number:
703-580-6596
Provider Enumeration Date:
02/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FINKLE
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
RCM SR. DIRECTOR
Authorized Official Telephone Number:
719-243-9490

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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