Provider Demographics
NPI:1851592182
Name:SUMMIT PEDIATRIC REHAB OF NO. VA, P.C.
Entity Type:Organization
Organization Name:SUMMIT PEDIATRIC REHAB OF NO. VA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-397-7003
Mailing Address - Street 1:2730 PROSPERITY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4330
Mailing Address - Country:US
Mailing Address - Phone:703-289-1435
Mailing Address - Fax:703-289-1414
Practice Address - Street 1:2826 OLD LEE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:877-703-3448
Practice Address - Fax:301-668-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Single Specialty