Provider Demographics
NPI:1548676307
Name:ADVANCED WORK REHAB CENTER, LLC
Entity type:Organization
Organization Name:ADVANCED WORK REHAB CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-330-3860
Mailing Address - Street 1:PO BOX 745977
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5977
Mailing Address - Country:US
Mailing Address - Phone:703-239-2305
Mailing Address - Fax:703-239-2306
Practice Address - Street 1:100 CONCOURSE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5642
Practice Address - Country:US
Practice Address - Phone:804-424-3356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty