# REHAB DIAGNOSTICS AND PAIN MEDICINE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104211648
- **Authorized official:** DR. YASSER GOUDA (OWNER)
- **Authorized official phone:** (267) 428-6454

## Contact information

- **Practice address:** 2121 N BROAD ST, LANSDALE, PA 19446-1054
- **Practice address phone:** (267) 428-6454
- **Practice address fax:** (267) 428-6457
- **Mailing address:** 2121 N BROAD ST, LANSDALE, PA 19446-1054
- **Mailing address phone:** (267) 428-6454
- **Mailing address fax:** (267) 428-6457

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD066786L | PA | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | MD066786L | PA | Yes |
| 208VP0000X | Pain Medicine Physician | MD066786L | PA | — |

## Other

- **Enumeration date:** 04/01/2015
- **Last updated:** 06/19/2015