Provider Demographics
NPI:1710459912
Name:FUNCTIONAL FREEDOM REHAB., INC.
Entity Type:Organization
Organization Name:FUNCTIONAL FREEDOM REHAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:276-601-2838
Mailing Address - Street 1:813 JOY RANCH RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-1305
Mailing Address - Country:US
Mailing Address - Phone:276-601-2838
Mailing Address - Fax:
Practice Address - Street 1:813 JOY RANCH RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-1305
Practice Address - Country:US
Practice Address - Phone:276-233-3584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty