Provider Demographics
NPI:1003195884
Name:TOTAL REHAB ANF FITNESS CENTER
Entity Type:Organization
Organization Name:TOTAL REHAB ANF FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-891-4224
Mailing Address - Street 1:10007 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9428
Mailing Address - Country:US
Mailing Address - Phone:540-891-4224
Mailing Address - Fax:540-891-4452
Practice Address - Street 1:10007 JEFFERSON DAVIS HWY
Practice Address - Street 2:127
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9428
Practice Address - Country:US
Practice Address - Phone:540-891-4224
Practice Address - Fax:540-891-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1012540302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA579422693AOtherMEDICARE