Healthcare Provider Details

I. General information

NPI: 1396713525
Provider Name (Legal Business Name): REHABILITATION EQUIPMENT PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 DUKE ST SUITE 12
ALEXANDRIA VA
22304-2924
US

IV. Provider business mailing address

5130 DUKE ST SUITE 12
ALEXANDRIA VA
22304-2924
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-2100
  • Fax:
Mailing address:
  • Phone: 703-370-2100
  • Fax: 703-370-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1590501
License Number StateVA

VIII. Authorized Official

Name: MR. SHAD LOFGREEN
Title or Position: COO
Credential:
Phone: 703-370-2100