Healthcare Provider Details

I. General information

NPI: 1548676307
Provider Name (Legal Business Name): ADVANCED WORK REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONCOURSE BLVD STE 140
GLEN ALLEN VA
23059-5642
US

IV. Provider business mailing address

PO BOX 745977
ATLANTA GA
30374-5977
US

V. Phone/Fax

Practice location:
  • Phone: 804-424-3356
  • Fax:
Mailing address:
  • Phone: 703-239-2305
  • Fax: 703-239-2306

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

VIII. Authorized Official

Name: NATHAN SCOTT MICHELS
Title or Position: PT
Credential:
Phone: 804-330-3860