Provider Demographics
NPI:1396108551
Name:NEUROGROW BRAIN FITNESS CENTER
Entity type:Organization
Organization Name:NEUROGROW BRAIN FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTUHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-462-9296
Mailing Address - Street 1:8280 GREENSBORO DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4905
Mailing Address - Country:US
Mailing Address - Phone:703-462-9296
Mailing Address - Fax:703-462-9269
Practice Address - Street 1:8280 GREENSBORO DR
Practice Address - Street 2:SUITE 240
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4905
Practice Address - Country:US
Practice Address - Phone:703-462-9296
Practice Address - Fax:703-462-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty