Provider Demographics
NPI:1447405931
Name:RAPPAHANNOCK FOOT & ANKLE SPECIALIST
Entity Type:Organization
Organization Name:RAPPAHANNOCK FOOT & ANKLE SPECIALIST
Other - Org Name:RAPPAHANNOCK FOOT & ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAN AMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-735-0260
Mailing Address - Street 1:195 FALCON DR
Mailing Address - Street 2:P.O. BOX 8389
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1930
Mailing Address - Country:US
Mailing Address - Phone:540-735-0260
Mailing Address - Fax:540-735-0262
Practice Address - Street 1:195 FALCON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1930
Practice Address - Country:US
Practice Address - Phone:540-735-0260
Practice Address - Fax:540-735-0262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAPPAHANNOCK FOOT AND ANKLE SPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-25
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204442225100000X
VA2306001121225200000X
VA2306000293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty