Provider Demographics
NPI:1255443248
Name:VALLEY REHABILITATION INC PC
Entity type:Organization
Organization Name:VALLEY REHABILITATION INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:MOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-772-2390
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:VALLEY REHABILITATION INC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015
Mailing Address - Country:US
Mailing Address - Phone:540-981-0672
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:VALLEY REHABILITATION INC
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-772-2390
Practice Address - Fax:540-772-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045890208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06989Medicare PIN