Healthcare Provider Details

I. General information

NPI: 1083714505
Provider Name (Legal Business Name): NATIONAL REHABILITATION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6642 SAINT JOE RD
FORT WAYNE IN
46835-1933
US

IV. Provider business mailing address

5029 BACKLICK RD # A
ANNANDALE VA
22003-6044
US

V. Phone/Fax

Practice location:
  • Phone: 260-492-6197
  • Fax:
Mailing address:
  • Phone: 260-492-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number05004444A
License Number StateIN

VIII. Authorized Official

Name: DR. MOHAMMED MOTAWEA
Title or Position: ADMINSTRATOR
Credential:
Phone: 260-492-6197