Provider Demographics
NPI:1720184732
Name:SPINE AND ORTHOPEDIC REHAB OF VA INC
Entity Type:Organization
Organization Name:SPINE AND ORTHOPEDIC REHAB OF VA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-985-6500
Mailing Address - Street 1:PO BOX 8763
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0732
Mailing Address - Country:US
Mailing Address - Phone:540-985-6500
Mailing Address - Fax:540-985-6501
Practice Address - Street 1:5238 VALLEYPOINTE PKWY STE 5
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3066
Practice Address - Country:US
Practice Address - Phone:540-366-9244
Practice Address - Fax:540-366-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADA1361Medicare PIN
VAC08605Medicare PIN