Healthcare Provider Details

I. General information

NPI: 1649357609
Provider Name (Legal Business Name): INOVA PHYSICAL REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 TELESTAR CT 3RD FLOOR
FALLS CHURCH VA
22042-1207
US

IV. Provider business mailing address

2990 TELESTAR CT SUITE 3PT
FALLS CHURCH VA
22042-1207
US

V. Phone/Fax

Practice location:
  • Phone: 571-423-5742
  • Fax: 571-423-5775
Mailing address:
  • Phone: 571-423-5742
  • Fax: 571-423-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE RICHE
Title or Position: EXECUTIVE DIRECTOR
Credential: PT
Phone: 703-279-4307