Provider Demographics
NPI:1689983298
Name:NOVA REHABILITATION INC
Entity Type:Organization
Organization Name:NOVA REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-415-6037
Mailing Address - Street 1:19490 SANDRIDGE WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3465
Mailing Address - Country:US
Mailing Address - Phone:703-415-6037
Mailing Address - Fax:
Practice Address - Street 1:19490 SANDRIDGE WAY
Practice Address - Street 2:SUITE 170
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-3465
Practice Address - Country:US
Practice Address - Phone:703-723-4088
Practice Address - Fax:703-723-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205535261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA421Medicare PIN