Provider Demographics
NPI:1063998417
Name:VA TOTAL REHAB, LLC
Entity type:Organization
Organization Name:VA TOTAL REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:703-471-4600
Mailing Address - Street 1:1760 RESTON PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3359
Mailing Address - Country:US
Mailing Address - Phone:703-471-4600
Mailing Address - Fax:703-997-7488
Practice Address - Street 1:1760 RESTON PKWY STE 310
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3359
Practice Address - Country:US
Practice Address - Phone:703-471-4600
Practice Address - Fax:703-997-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty