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General NPI Number Information
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NPI Number | 1245809706
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Entity Type | Organization
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Legal Business Name | PHYSICAL REHABILITATION LLC
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Dates
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Enumeration Date | 06/20/2021
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Last Update Date | 06/20/2021
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Provider Practice Location Address
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Address Line | 1401 JOHNSTON WILLIS DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 804-281-4305
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Fax | 804-281-4310
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Provider Business Mailing Address
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Address Line | 1806 SUMMIT AVENUE SUITE 300 #506
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City | RICHMOND
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State | VA
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Zip | 23230
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Country | US
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Telephone | 804-281-4305
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Fax | 804-281-4310
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDOLPH M JENKINS JR.
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Credential | MD
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Telephone | 804-281-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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