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NPI Code Detail

MEDICARE: SPINE AND SPORT REHAB CENTER INC

MEDICARE: SPINE AND SPORT REHAB CENTER 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
1273Y00000XRehabilitation Hospital Unit0104556081VA

General Provider Information

NPI Number : 1841489531
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPINE AND SPORT REHAB CENTER INC
Provider Business Mailing Address
First Line : 4656D KING ST
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1215
Country : US
Telephone Number : 703-998-0600
Fax Number : 703-998-0333
Provider Business Practice Location Address
First Line : 4656D KING ST
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1215
Country : US
Telephone Number : 703-998-0600
Fax Number : 703-998-0333
Authorized Official
Title or Position : PRESIDENT
Name : DR. NATHAN LE
Credential : DC
Telephone Number : 703-998-0600
Provider Enumeration Date : 10/17/2007
Last Update Date : 03/21/2013

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Directions to “SPINE AND SPORT REHAB CENTER INC ” Practice Location

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