Yes, I think 240s are plenty. Apply broadly and show in your application that you have exposure to the field along with letters from PM&R doctors. Top tier programs may not give you offers simply because you didn't do your medical education in the United States. I think you will match somewhere as long as you're flexible.
I’d audition at places with a history of taking IMG/FMGs. I believe my advice thread in the stickies listed some of the programs. You are at a significant disadvantage...and you will need to do the right things to alleviate the perceived red flags carried by IMG/FMG. Rock the boards and doing VERY well (especially in the interpersonal department) on auditions are good starts.
I’d audition at places with a history of taking IMG/FMGs. I believe my advice thread in the stickies listed some of the programs. You are at a significant disadvantage...and you will need to do the right things to alleviate the perceived red flags carried by IMG/FMG. Rock the boards and doing VERY well (especially in the interpersonal department) are good starts.