Healthcare Provider Details

I. General information

NPI: 1487948980
Provider Name (Legal Business Name): VIRGINIA PAIN & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 WILSON BLVD 2ND FLOOR
ARLINGTON VA
22205-1169
US

IV. Provider business mailing address

5130 WILSON BLVD 2ND FLOOR
ARLINGTON VA
22205-1169
US

V. Phone/Fax

Practice location:
  • Phone: 703-247-9799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM RYAN
Title or Position: OWNER
Credential:
Phone: 405-926-7926