Provider Demographics
NPI:1154511624
Name:VIRGINIA PAIN & REHABILITATION CENTER, PLLC
Entity Type:Organization
Organization Name:VIRGINIA PAIN & REHABILITATION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-598-5910
Mailing Address - Street 1:6620 KEENE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2508
Mailing Address - Country:US
Mailing Address - Phone:703-598-5910
Mailing Address - Fax:703-639-0738
Practice Address - Street 1:6620 KEENE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2508
Practice Address - Country:US
Practice Address - Phone:703-598-5910
Practice Address - Fax:703-639-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233304261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation