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General NPI Number Information
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NPI Number | 1326334244
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Entity Type | Organization
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Legal Business Name | CHANTILLY REHAB PHYSICIANS PC
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 24430 MILLSTREAM DR
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City | ALDIE
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State | VA
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Zip | 20105-3098
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Country | US
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Telephone | 703-991-9778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2207
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City | FAIRFAX
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State | VA
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Zip | 22031-0207
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Country | US
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Telephone | 703-991-9778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAIK SAMDANI
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Credential | MD
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Telephone | 703-991-9778
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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 | 0101238655
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License Number State | VA
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