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General NPI Number Information
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NPI Number | 1225121296
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Entity Type | Organization
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Legal Business Name | ROANOKE REHABILITATION & WELLNESS, INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 2149 ELECTRIC RD, SUITE 10
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-774-9000
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Fax | 540-774-6666
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Provider Business Mailing Address
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Address Line | 2149 ELECTRIC RD, SUITE 10
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-774-9000
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Fax | 540-774-6666
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GAYLE F. KEITH
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Credential |
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Telephone | 540-314-1046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305003792
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License Number State | VA
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