Provider Demographics
NPI:1922325208
Name:CENTER FOR NEUROMUSCULAR AND MASSAGE REHABILITATION
Entity Type:Organization
Organization Name:CENTER FOR NEUROMUSCULAR AND MASSAGE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KULA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:202-257-1363
Mailing Address - Street 1:68 NEWBURY DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4620
Mailing Address - Country:US
Mailing Address - Phone:202-257-1363
Mailing Address - Fax:888-839-9091
Practice Address - Street 1:1712 EYE ST NW
Practice Address - Street 2:BASEMENT # 110
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3702
Practice Address - Country:US
Practice Address - Phone:202-257-1363
Practice Address - Fax:888-839-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC870635261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy