Healthcare Provider Details

I. General information

NPI: 1952768905
Provider Name (Legal Business Name): UNITED WELLNESS CENTER AND SPORTS REHAB FC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W ANNANDALE RD SUITE 300
FALLS CHURCH VA
22046-4226
US

IV. Provider business mailing address

510 W ANNANDALE RD SUITE 300
FALLS CHURCH VA
22046-4226
US

V. Phone/Fax

Practice location:
  • Phone: 703-600-8208
  • Fax: 703-437-2404
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104001895
License Number StateVA

VIII. Authorized Official

Name: HIRAD NAJAFBAGY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 703-437-8195