Provider Demographics
NPI:1356592802
Name:COMPREHENSIVE PHYSICAL MEDICINE AND REHABILITATION, PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE PHYSICAL MEDICINE AND REHABILITATION, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-907-4573
Mailing Address - Street 1:5046 HUNTING HILLS SQ
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8768
Mailing Address - Country:US
Mailing Address - Phone:480-907-4573
Mailing Address - Fax:602-490-9438
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:809-074-5734
Practice Address - Fax:602-491-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947864Medicaid
AZ10809160OtherCAQH
G28907Medicare UPIN