Healthcare Provider Details

I. General information

NPI: 1457590127
Provider Name (Legal Business Name): REHAB MASTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12191 CLIPPER DR
LAKE RIDGE VA
22192-2237
US

IV. Provider business mailing address

8711 E PINNACLE PEAK RD # 347
SCOTTSDALE AZ
85255-3517
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-3486
  • Fax:
Mailing address:
  • Phone: 480-473-3790
  • Fax: 480-473-3791

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 Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BLAKE GILLMAN
Title or Position: PRESIDENT
Credential:
Phone: 480-473-3790