Provider Demographics
NPI:1902358625
Name:HEALTH MANAGEMENT AND REHABILITATION LLC
Entity Type:Organization
Organization Name:HEALTH MANAGEMENT AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYARATHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-752-5887
Mailing Address - Street 1:13907 WILLOW TREE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5434
Mailing Address - Country:US
Mailing Address - Phone:540-752-5887
Mailing Address - Fax:
Practice Address - Street 1:1051 CARE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8425
Practice Address - Country:US
Practice Address - Phone:240-778-3761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012545692081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADU4729Medicare PIN