Provider Demographics
NPI:1952768905
Name:UNITED WELLNESS CENTER AND SPORTS REHAB FC LLC
Entity Type:Organization
Organization Name:UNITED WELLNESS CENTER AND SPORTS REHAB FC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HIRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJAFBAGY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-437-8195
Mailing Address - Street 1:510 W ANNANDALE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 W ANNANDALE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4226
Practice Address - Country:US
Practice Address - Phone:703-600-8208
Practice Address - Fax:703-437-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001895111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA169218OtherMEDICARE PTAN