Provider Demographics
NPI:1306959218
Name:CENTER FOR PHYSICAL MEDICINE & REHABILITATION P C
Entity type:Organization
Organization Name:CENTER FOR PHYSICAL MEDICINE & REHABILITATION P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-246-9002
Mailing Address - Street 1:1331 N 7TH ST STE 360
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2772
Mailing Address - Country:US
Mailing Address - Phone:602-246-9002
Mailing Address - Fax:602-246-7950
Practice Address - Street 1:7600 N 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4330
Practice Address - Country:US
Practice Address - Phone:602-246-7410
Practice Address - Fax:602-246-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty