Provider Demographics
NPI:1891706586
Name:BODY KINETICS REHAB LLC.
Entity Type:Organization
Organization Name:BODY KINETICS REHAB LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIBHAKAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:KARAMBELKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-639-0950
Mailing Address - Street 1:7617 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3643
Mailing Address - Country:US
Mailing Address - Phone:703-639-0950
Mailing Address - Fax:703-663-8730
Practice Address - Street 1:7617 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 110
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3643
Practice Address - Country:US
Practice Address - Phone:703-639-0950
Practice Address - Fax:703-663-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 2251N0400X, 2251P0200X, 2251X0800X, 225X00000X, 235Z00000X
VA23052032862251N0400X, 2251P0200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891706586Medicaid