Provider Demographics
NPI:1073937769
Name:NOVA IN-HOME THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:NOVA IN-HOME THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-342-0908
Mailing Address - Street 1:3178 SUMMIT SQUARE DR APT D8
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2880
Mailing Address - Country:US
Mailing Address - Phone:516-342-0908
Mailing Address - Fax:
Practice Address - Street 1:3178 SUMMIT SQUARE DR APT D8
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2880
Practice Address - Country:US
Practice Address - Phone:516-342-0908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health