Healthcare Provider Details

I. General information

NPI: 1134314966
Provider Name (Legal Business Name): CAPITOL REHAB OF WINCHESTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 COSTELLO DR
WINCHESTER VA
22602-4306
US

IV. Provider business mailing address

172 COSTELLO DR
WINCHESTER VA
22602-4306
US

V. Phone/Fax

Practice location:
  • Phone: 540-665-4444
  • Fax:
Mailing address:
  • Phone: 540-665-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number0104001664
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DOEPPER
Title or Position: OFFICE MANAGER
Credential:
Phone: 540-665-4444