Healthcare Provider Details

I. General information

NPI: 1053470211
Provider Name (Legal Business Name): RAAB C REIBACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BELLVIEW AVE
WINCHESTER VA
22601-3142
US

IV. Provider business mailing address

120 BELLVIEW AVE
WINCHESTER VA
22601-3142
US

V. Phone/Fax

Practice location:
  • Phone: 540-542-0200
  • Fax:
Mailing address:
  • Phone: 540-542-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119001431
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: