| Name: | Physical Medicine & Rehabilitation Associates of East Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 20 Mar 2018 (7 years ago) |
| Entity Number: | 000-513-633 |
| Register Number: | 000513633 |
| County: | Lee |
| Place of Formation: | Lee County |
| Registered Office Street Address: | 716 BANBURY STAUBURN, AL 36832 |
| Registered Office Street Address ZIP Code: | 36832 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861972002 | 2018-08-17 | 2018-08-17 | 716 BANBURY ST, AUBURN, AL, 368323677, US | 267 FOB JAMES DR, VALLEY, AL, 368545077, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 718-216-8283 |
Authorized person
| Name | DR. FREDERICK MANSUR AZIZ |
| Role | PRESIDENT |
| Phone | 7182168283 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | 35113 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 2081P0301X - Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | 35113 |
| State | AL |
| Is Primary | No |
| Name | Role |
|---|---|
| AZIZ, FREDERICK | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
