Provider Demographics
NPI:1649357609
Name:INOVA PHYSICAL REHABILITATION SERVICES
Entity type:Organization
Organization Name:INOVA PHYSICAL REHABILITATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-279-4307
Mailing Address - Street 1:2990 TELESTAR CT
Mailing Address - Street 2:SUITE 3PT
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1207
Mailing Address - Country:US
Mailing Address - Phone:571-423-5742
Mailing Address - Fax:571-423-5775
Practice Address - Street 1:2990 TELESTAR CT
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1207
Practice Address - Country:US
Practice Address - Phone:571-423-5742
Practice Address - Fax:571-423-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979915Medicaid
VA004979753Medicaid
VA010105064Medicaid
VA004980921Medicaid
VA004980905Medicaid
VA004980913Medicaid
VA004980875Medicaid
VA010274630Medicaid
VA004980921Medicaid
VA004979915Medicaid