Healthcare Provider Details

I. General information

NPI: 1720393879
Provider Name (Legal Business Name): STEADFAST REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 TWEEDSMUIR TURN
MOSELEY VA
23120-1287
US

IV. Provider business mailing address

4513 TWEEDSMUIR TURN
MOSELEY VA
23120-1287
US

V. Phone/Fax

Practice location:
  • Phone: 804-513-3810
  • Fax: 804-639-7124
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2202001943
License Number StateVA

VIII. Authorized Official

Name: LINDA FLAMM
Title or Position: OWNER/SPEECH THERAPIST
Credential:
Phone: 804-513-3810