MEDICARE: VIRGINIA PAIN & REHABILITATION CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	0101233304	VA

General Provider Information

NPI Number	:	1154511624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA PAIN & REHABILITATION CENTER, PLLC

Provider Business Mailing Address
First Line	:	6620 KEENE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2508
Country	:	US
Telephone Number	:	703-598-5910
Fax Number	:	703-639-0738

Provider Business Practice Location Address
First Line	:	6620 KEENE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2508
Country	:	US
Telephone Number	:	703-598-5910
Fax Number	:	703-639-0738

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHUONG XUAN MAI
Credential	:	MD
Telephone Number	:	703-598-5910

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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