Basic Information
| Provider Information | |||||||||
| NPI: | 1477846640 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDLOTHIAN REHABILITATION ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 HETH CT | ||||||||
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| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231145532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048973455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 95 MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238059280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045048100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2011 | ||||||||
| LastUpdateDate: | 05/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | GOULMAMINE | ||||||||
| AuthorizedOfficialFirstName: | REDOUANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8048973455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 0101242555 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.