Provider Demographics
NPI:1851836316
Name:DRIVER REHABILITATION CENTER OF EXCELLENCE, LLC
Entity Type:Organization
Organization Name:DRIVER REHABILITATION CENTER OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CDRS
Authorized Official - Phone:703-345-2990
Mailing Address - Street 1:14101 PARKE LONG CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1645
Mailing Address - Country:US
Mailing Address - Phone:703-345-2990
Mailing Address - Fax:
Practice Address - Street 1:14101 PARKE LONG CT
Practice Address - Street 2:SUITE E
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1645
Practice Address - Country:US
Practice Address - Phone:703-345-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty