Provider Demographics
NPI:1366143026
Name:PHYSIATRY MEDICAL CONSULTING, INC.
Entity type:Organization
Organization Name:PHYSIATRY MEDICAL CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-901-2855
Mailing Address - Street 1:5135 DEERHURST CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8532
Mailing Address - Country:US
Mailing Address - Phone:561-901-2855
Mailing Address - Fax:
Practice Address - Street 1:6363 VERDE TRL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7702
Practice Address - Country:US
Practice Address - Phone:561-483-9282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty