Provider Demographics
NPI:1427007665
Name:WATAUGA REHABILITATION, INC.
Entity Type:Organization
Organization Name:WATAUGA REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-628-8113
Mailing Address - Street 1:PO BOX 1823
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1823
Mailing Address - Country:US
Mailing Address - Phone:276-628-8113
Mailing Address - Fax:276-628-8032
Practice Address - Street 1:16487 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7449
Practice Address - Country:US
Practice Address - Phone:276-628-8113
Practice Address - Fax:276-628-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9102591Medicaid
VA9102591Medicaid