Provider Demographics
NPI:1376621243
Name:CONCUSSION CARE CENTRE OF VA
Entity Type:Organization
Organization Name:CONCUSSION CARE CENTRE OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZASLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-346-1803
Mailing Address - Street 1:3721 WESTERRE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1332
Mailing Address - Country:US
Mailing Address - Phone:804-270-5484
Mailing Address - Fax:804-270-1220
Practice Address - Street 1:3721 WESTERRE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1332
Practice Address - Country:US
Practice Address - Phone:804-270-5484
Practice Address - Fax:804-270-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044265208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty