Provider Demographics
NPI:1366516528
Name:CAPREHAB ASHBURN, LLC
Entity type:Organization
Organization Name:CAPREHAB ASHBURN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PIETRANTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-726-9866
Mailing Address - Street 1:42882 TRURO PARISH DR
Mailing Address - Street 2:UNIT 207
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4456
Mailing Address - Country:US
Mailing Address - Phone:703-726-9866
Mailing Address - Fax:703-726-9868
Practice Address - Street 1:42882 TRURO PARISH DR
Practice Address - Street 2:UNIT 207
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-4456
Practice Address - Country:US
Practice Address - Phone:703-726-9866
Practice Address - Fax:703-726-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004524225100000X
VA0104556089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556089OtherVA LICENSE