Healthcare Provider Details

I. General information

NPI: 1497967251
Provider Name (Legal Business Name): SPORT & SPINE OF REHAB MCLEAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 425
MC LEAN VA
22101-6007
US

IV. Provider business mailing address

9300 LIVINGSTON RD STE 100
FT WASHINGTON MD
20744-4914
US

V. Phone/Fax

Practice location:
  • Phone: 703-448-5799
  • Fax: 240-766-0304
Mailing address:
  • Phone: 240-766-0300
  • Fax: 240-766-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY S GREENSTEIN
Title or Position: CEO
Credential: DC
Phone: 240-766-0300