Provider Demographics
NPI:1538313937
Name:CAPITOL REHAB CENTER OF HERNDON, LLC
Entity Type:Organization
Organization Name:CAPITOL REHAB CENTER OF HERNDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JI
Authorized Official - Middle Name:HYUNG
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-787-3850
Mailing Address - Street 1:171 ELDEN ST STE 3A3
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4869
Mailing Address - Country:US
Mailing Address - Phone:703-787-3850
Mailing Address - Fax:703-787-3851
Practice Address - Street 1:459 HERNDON PKWY
Practice Address - Street 2:SUITE 15
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-6220
Practice Address - Country:US
Practice Address - Phone:703-787-3850
Practice Address - Fax:703-787-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556197111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty