MEDICARE: SUNDANCE REHABILITION

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	314000000X	Skilled Nursing Facility	0131000595	VA

General Provider Information

NPI Number	:	1972848273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNDANCE REHABILITION

Provider Business Mailing Address
First Line	:	2314 S INGE ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-2457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9160 BELVOIR WOODS PKWY
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2703
Country	:	US
Telephone Number	:	703-781-2447
Fax Number	:

Authorized Official
Title or Position	:	THERAPY PROGRAM MANAGER
Name	:	CASSIE EDGREEN
Credential	:
Telephone Number	:	703-781-2447

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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