Punnamma Memorial Rehab Clinic

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

17059 Issued in WV

Legal business name

PUNNAMMA MEMORIAL REHAB CLINIC

Practice address

1504 Grand Central Ave
Vienna, WV 26105-1058

Phone

(304) 485-7500

Fax

(304) 485-6777

NPI assigned

Jan 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Sandya Rani Kalapala

Title

Office Manager

Phone

(304) 485-7500

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PMR Clinic Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550707200000",
    "number": "1861549941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 MURDOCH AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261012532",
            "telephone_number": "304-485-7500",
            "fax_number": "304-485-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 GRAND CENTRAL AVE",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261051058",
            "telephone_number": "304-485-7500",
            "fax_number": "304-485-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUNNAMMA MEMORIAL REHAB CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2019-02-21",
        "status": "A",
        "authorized_official_last_name": "KALAPALA",
        "authorized_official_first_name": "SANDYA",
        "authorized_official_middle_name": "RANI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-485-7500",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "20619",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "21321",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WV",
            "license": "17059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0078260000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0203567000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMR Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PMR Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Medicine & Rehabilitation Physician in Vienna, WV
• Providers in Vienna, WV by specialty
• Physical Medicine & Rehabilitation Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.