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General NPI Number Information
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NPI Number | 1083714505
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Entity Type | Organization
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Legal Business Name | NATIONAL REHABILITATION CARE
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6642 SAINT JOE RD
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City | FORT WAYNE
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State | IN
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Zip | 46835-1933
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Country | US
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Telephone | 260-492-6197
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 BACKLICK RD # A
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City | ANNANDALE
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State | VA
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Zip | 22003-6044
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Country | US
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Telephone | 260-492-6197
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | DR. MOHAMMED MOTAWEA
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Credential |
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Telephone | 260-492-6197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 05004444A
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License Number State | IN
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