Provider Demographics
NPI:1316139991
Name:PHYSICAL MEDICINE & REHAB SERVICES LLC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE & REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BINDU
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHENNATTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-371-0433
Mailing Address - Street 1:3070 MAIN ST
Mailing Address - Street 2:PVT
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4219
Mailing Address - Country:US
Mailing Address - Phone:203-371-0433
Mailing Address - Fax:203-549-0919
Practice Address - Street 1:3070 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4219
Practice Address - Country:US
Practice Address - Phone:203-371-0433
Practice Address - Fax:203-549-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation