Provider Demographics
NPI:1841470606
Name:OPEQUON REHABILITATION & WELLNESS, PC
Entity type:Organization
Organization Name:OPEQUON REHABILITATION & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SHELBY
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:540-535-2228
Mailing Address - Street 1:3107 VALLEY AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2675
Mailing Address - Country:US
Mailing Address - Phone:540-535-2228
Mailing Address - Fax:540-535-2204
Practice Address - Street 1:3107 VALLEY AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2675
Practice Address - Country:US
Practice Address - Phone:540-535-2228
Practice Address - Fax:540-535-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050039512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10395OtherMEDICARE GROUP PTAN