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General NPI Number Information
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NPI Number | 1699832782
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Entity Type | Organization
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Legal Business Name | CAPITOL REHAB ANNANDALE, INC.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 6940A BRADLICK SHOPPING CTR
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City | ANNANDALE
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State | VA
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Zip | 22003-7205
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Country | US
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Telephone | 703-333-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 6940A BRADLICK SHOPPING CTR
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City | ANNANDALE
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State | VA
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Zip | 22003-7205
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Country | US
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Telephone | 703-333-5022
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD REZA KOMAILY
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Credential | DC
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Telephone | 703-333-5022
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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 | 0104556483
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License Number State | VA
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