Provider Demographics
NPI:1396063160
Name:AFFILIATED REHAB, P.C.
Entity type:Organization
Organization Name:AFFILIATED REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:LATHAM
Authorized Official - Last Name:KITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-563-8502
Mailing Address - Street 1:5012 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019
Mailing Address - Country:US
Mailing Address - Phone:540-563-8502
Mailing Address - Fax:540-563-8456
Practice Address - Street 1:5012 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019
Practice Address - Country:US
Practice Address - Phone:540-563-8502
Practice Address - Fax:540-563-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty