1649357609 NPI number — INOVA PHYSICAL REHABILITATION SERVICES

Table of content: (NPI 1649357609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649357609 NPI number — INOVA PHYSICAL REHABILITATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INOVA PHYSICAL REHABILITATION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INOVA PHYSICAL THERAPY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649357609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2990 TELESTAR CT
Provider Second Line Business Mailing Address:
SUITE 3PT
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-423-5742
Provider Business Mailing Address Fax Number:
571-423-5775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2990 TELESTAR CT
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-423-5742
Provider Business Practice Location Address Fax Number:
571-423-5775
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHE
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
703-279-4307

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004979915 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004979753 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010105064 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004980921 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004980905 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004980913 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004980875 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010274630 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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