Provider Demographics
NPI:1114923786
Name:HANOVER REHABILITATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HANOVER REHABILITATION ASSOCIATES, LLC
Other - Org Name:WEST POINT PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-730-7730
Mailing Address - Street 1:7496 LEE DAVIS RD
Mailing Address - Street 2:STE 19
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3678
Mailing Address - Country:US
Mailing Address - Phone:804-730-7730
Mailing Address - Fax:804-730-7541
Practice Address - Street 1:7496 LEE DAVIS RD
Practice Address - Street 2:STE 19
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3678
Practice Address - Country:US
Practice Address - Phone:804-730-7730
Practice Address - Fax:804-730-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050023662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001H01Medicare PIN
VAR65356Medicare UPIN
VAP17734Medicare UPIN
012207H26Medicare PIN