Healthcare Provider Details

I. General information

NPI: 1972686780
Provider Name (Legal Business Name): VIRGINIA HEALTH REHABILITATION AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WILLIAM STYRON SQ S
NEWPORT NEWS VA
23606
US

IV. Provider business mailing address

240 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-0020
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-0330
  • Fax: 757-594-0332
Mailing address:
  • Phone: 757-595-1946
  • Fax: 757-596-3621

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: MRS. NICOLE L BOLDY
Title or Position: CFO
Credential:
Phone: 757-599-7422