MEDICARE: SPINE AND ORTHOPEDIC REHAB OF VA INC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1295831113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND ORTHOPEDIC REHAB OF VA INC

Provider Business Mailing Address
First Line	:	PO BOX 8763
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-0732
Country	:	US
Telephone Number	:	540-985-6500
Fax Number	:	540-985-6501

Provider Business Practice Location Address
First Line	:	1310 3RD ST SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-5219
Country	:	US
Telephone Number	:	540-985-6500
Fax Number	:	540-985-6501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC REICHARDT
Credential	:	MFT
Telephone Number	:	540-985-6500

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	11/05/2020

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