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General NPI Number Information
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NPI Number | 1174735856
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Entity Type | Organization
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Legal Business Name | SPORT AND SPINE REHAB OF FAIRFAX
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 10807 MAIN STREET
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City | FAIRFAX
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State | VA
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Zip | 22303
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Country | US
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Telephone | 703-890-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 11418 LIVINGSTON ROAD
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City | FT. WASHINGTON
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State | MD
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Zip | 20744
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Country | US
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Telephone | 240-766-0300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JAY GREENSTEIN
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Credential | DC
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Telephone | 240-766-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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