Provider Demographics
NPI:1558667618
Name:AMERICAN REHABILITATION & ELECTRODIAGNOSTICS PC
Entity Type:Organization
Organization Name:AMERICAN REHABILITATION & ELECTRODIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MERVET
Authorized Official - Middle Name:
Authorized Official - Last Name:ELASSAL-MAXIMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-774-2500
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0441
Mailing Address - Country:US
Mailing Address - Phone:434-447-8580
Mailing Address - Fax:434-447-8538
Practice Address - Street 1:413 BRACEY LN
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1632
Practice Address - Country:US
Practice Address - Phone:434-774-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty