Basic Information
| Provider Information | |||||||||
| NPI: | 1336155845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOENIX REHABILITATION AND HEALTH SERVICES OF VIRGINIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 392573 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152519573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244482733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 WESTINGHOUSE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | CRANBERRY TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160665238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248319293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | CONFER | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7244482733 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHOENIX REHABILITATION AND HEALTH SERVICES, INC. | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | C09457 | 01 | VA | MEDICARE IDENTIFICATION NUMBER | OTHER |