# SOUTHERN PHYSICAL MEDICINE ASSOCIATES INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Physical Medicine Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134338361
- **Authorized official:** DR. CHARLES H BONNER SR. (PRESIDENT)
- **Authorized official phone:** (804) 282-6593

## Contact information

- **Practice address:** 5922 W BROAD ST, RICHMOND, VA 23230-2231
- **Practice address phone:** (804) 282-6593
- **Practice address fax:** (804) 282-8215
- **Mailing address:** 5922 W BROAD ST, RICHMOND, VA 23230-2231
- **Mailing address phone:** (804) 282-6953
- **Mailing address fax:** (804) 282-8215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | 0715002791 | VA | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | 0101032689 | VA | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 0101032689 | VA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 0101032689 | VA | Yes |
| 2081P0004X | Spinal Cord Injury Medicine Physician | 0101032689 | VA | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 0101032689 | VA | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | 0101032689 | VA | — |
| 208VP0014X | Interventional Pain Medicine Physician | 0101032689 | VA | — |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 07/31/2012