Provider Demographics
NPI:1396713525
Name:REHABILITATION EQUIPMENT PROFESSIONALS
Entity type:Organization
Organization Name:REHABILITATION EQUIPMENT PROFESSIONALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFGREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-370-2100
Mailing Address - Street 1:5130 DUKE ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2924
Mailing Address - Country:US
Mailing Address - Phone:703-370-2100
Mailing Address - Fax:703-370-7985
Practice Address - Street 1:5130 DUKE ST
Practice Address - Street 2:SUITE 12
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2924
Practice Address - Country:US
Practice Address - Phone:703-370-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1590501332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025159700Medicaid
VA009135570Medicaid
MD627888400Medicaid
MDME66OtherCAREFIRST BCBS
VA009135570Medicaid
DC0307210001Medicare NSC
MD0307210001Medicare NSC
207947Medicare PIN