| Physical Medicine Center | |
|
5922 W Broad St Richmond VA 23230-2231 | |
| (804) 282-6593 | |
| (804) 282-8215 |
| Full Name | Physical Medicine Center |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 5922 W Broad St, Richmond, Virginia |
| Authorized Official Name and Position | Charles H Bonner (PRESIDENT) |
| Authorized Official Contact | 8042826593 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physical Medicine Center 5922 W Broad St Richmond VA 23230-2231 Ph: (804) 282-6953 | Physical Medicine Center 5922 W Broad St Richmond VA 23230-2231 Ph: (804) 282-6593 |
| NPI Number | 1134338361 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 07/31/2012 |
| Medicare PECOS PAC ID | 7416024922 |
|---|---|
| Medicare Enrollment ID | O20080925000397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134338361 | NPI | - | NPPES |
| 066834400 | Medicaid | VA |
| Provider Name | Charles H Bonner |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1710983283 PECOS PAC ID: 2668413212 Enrollment ID: I20050513000542 |
| Provider Name | Andrea M Kysor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851814909 PECOS PAC ID: 3577836535 Enrollment ID: I20170913002593 |
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