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General NPI Number Information
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NPI Number | 1952768905
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Entity Type | Organization
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Legal Business Name | UNITED WELLNESS CENTER AND SPORTS REHAB FC LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 510 W ANNANDALE RD SUITE 300
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4226
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Country | US
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Telephone | 703-600-8208
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Fax | 703-437-2404
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Provider Business Mailing Address
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Address Line | 510 W ANNANDALE RD SUITE 300
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | HIRAD NAJAFBAGY
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Credential |
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Telephone | 703-437-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 0104001895
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License Number State | VA
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