Healthcare Provider Details

I. General information

NPI: 1124190053
Provider Name (Legal Business Name): NOVA PAIN & REHAB CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14290 SULLYFIELD CIR SUITE 100
CHANTILLY VA
20151-4000
US

IV. Provider business mailing address

14290 SULLYFIELD CIR SUITE 100
CHANTILLY VA
20151-4000
US

V. Phone/Fax

Practice location:
  • Phone: 703-434-9324
  • Fax: 703-933-3745
Mailing address:
  • Phone: 703-434-9324
  • Fax: 703-933-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

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