Provider Demographics
NPI:1316052640
Name:PRO SPORTSCARE & REHAB LLC
Entity type:Organization
Organization Name:PRO SPORTSCARE & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-329-7004
Mailing Address - Street 1:3801 FAIRFAX DR
Mailing Address - Street 2:SUITE 60
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1762
Mailing Address - Country:US
Mailing Address - Phone:703-522-1060
Mailing Address - Fax:703-522-1080
Practice Address - Street 1:11200 SCAGGSVILLE RD
Practice Address - Street 2:UNIT 114
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2022
Practice Address - Country:US
Practice Address - Phone:301-317-8373
Practice Address - Fax:301-317-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty