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General NPI Number Information
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NPI Number | 1114923786
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Entity Type | Organization
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Legal Business Name | HANOVER REHABILITATION ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 7496 LEE DAVIS RD STE 19
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3678
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Country | US
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Telephone | 804-730-7730
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Fax | 804-730-7541
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Provider Business Mailing Address
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Address Line | 7496 LEE DAVIS RD STE 19
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3678
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Country | US
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Telephone | 804-730-7730
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Fax | 804-730-7541
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID JOE DURHAM
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Credential | PT
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Telephone | 804-730-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305002366
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License Number State | VA
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