Basic Information
| Provider Information | |||||||||
| NPI: | 1134204548 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODSTOCK REHAB & FITNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | POST OFFICE BOX 803 | ||||||||
| Address2: | 1195 HISEY AVENUE | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404597772 | ||||||||
| FaxNumber: | 5404597782 | ||||||||
| Practice Location | |||||||||
| Address1: | 1195 HISEY AVENUE | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404597772 | ||||||||
| FaxNumber: | 5404597782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | REICHLEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5404597772 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0105005306 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.