Healthcare Provider Details

I. General information

NPI: 1497824296
Provider Name (Legal Business Name): NORTHERN VIRGINIA PAIN AND REHAB CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 S GLEBE RD SUITE E
ARLINGTON VA
22206-2730
US

IV. Provider business mailing address

2955 S GLEBE RD SUITE E
ARLINGTON VA
22206-2730
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-8887
  • Fax: 703-535-7819
Mailing address:
  • Phone: 703-535-8887
  • Fax: 703-535-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. KARLA M HERAUD
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-535-8887