Provider Demographics
NPI:1962741074
Name:HAND AND UPPER EXTREMITY REHAB, LLC
Entity type:Organization
Organization Name:HAND AND UPPER EXTREMITY REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:703-565-4115
Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 417
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7182
Mailing Address - Country:US
Mailing Address - Phone:703-717-5667
Mailing Address - Fax:703-986-3108
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 417
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-717-5667
Practice Address - Fax:703-986-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000476335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGO2326Medicare PIN