Healthcare Provider Details

I. General information

NPI: 1851592182
Provider Name (Legal Business Name): SUMMIT PEDIATRIC REHAB OF NO. VA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 OLD LEE HWY SUITE 200
FAIRFAX VA
22031-4323
US

IV. Provider business mailing address

2730 PROSPERITY AVE STE B
FAIRFAX VA
22031-4330
US

V. Phone/Fax

Practice location:
  • Phone: 877-703-3448
  • Fax: 301-668-7008
Mailing address:
  • Phone: 703-289-1435
  • Fax: 703-289-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA VIOLA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 240-397-7003