MEDICARE: ADVANCED WORK REHAB CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1548676307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WORK REHAB CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 745977
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-5977
Country	:	US
Telephone Number	:	703-239-2305
Fax Number	:	703-239-2306

Provider Business Practice Location Address
First Line	:	100 CONCOURSE BLVD STE 140
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5642
Country	:	US
Telephone Number	:	804-424-3356
Fax Number	:

Authorized Official
Title or Position	:	PT
Name	:	NATHAN SCOTT MICHELS
Credential	:
Telephone Number	:	804-330-3860

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	05/21/2024

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