=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235558347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DYNAMIC REHAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2014
-----------------------------------------------------
Last Update Date | 07/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8316 ARLINGTON BLVD STE 520
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-5216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-205-1999
-----------------------------------------------------
Fax | 703-205-1911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8316 ARLINGTON BLVD
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-5207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-205-1999
-----------------------------------------------------
Fax | 703-205-1911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/DIRECTOR
-----------------------------------------------------
Name | MR. HAMID ESPANDYARI
-----------------------------------------------------
Credential | BS
-----------------------------------------------------
Telephone | 703-930-1704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 2305004058
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------