Provider Demographics
NPI:1699832782
Name:CAPITOL REHAB ANNANDALE, INC.
Entity Type:Organization
Organization Name:CAPITOL REHAB ANNANDALE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:KOMAILY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-333-5022
Mailing Address - Street 1:6940A BRADLICK SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-7205
Mailing Address - Country:US
Mailing Address - Phone:703-333-5022
Mailing Address - Fax:
Practice Address - Street 1:6940A BRADLICK SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7205
Practice Address - Country:US
Practice Address - Phone:703-333-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487735007OtherNPI - DR. MO KOMAILY
VA1245391226OtherNPI - DR JEREMY SCHMIDT
VAV01315Medicare UPIN