Provider Demographics
NPI:1174777874
Name:PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF NW AR PA
Entity type:Organization
Organization Name:PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF NW AR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATINCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-246-9002
Mailing Address - Street 1:2054 S 54TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8196
Mailing Address - Country:US
Mailing Address - Phone:479-246-9002
Mailing Address - Fax:479-246-9005
Practice Address - Street 1:2054 S 54TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8196
Practice Address - Country:US
Practice Address - Phone:479-246-9002
Practice Address - Fax:479-246-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1930225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty