NPIMap

Organization Active NPI

Fairfax Rehabilitation, Incorporated

  • Rehabilitation Clinic/Center
  • Fairfax, VA
National Provider Identifier
1285612283
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
2305001398 Issued in VA
Legal business name
FAIRFAX REHABILITATION, INCORPORATED
Practice address
10301 Democracy LN
Suite 100
Fairfax, VA 22030-2545
Phone
(703) 273-9191
Fax
(703) 273-9213
NPI assigned
Jan 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Melanie Rochon Bush, PT
Title
President
Phone
(703) 273-9191

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X 2305001398 VA Primary
Rehabilitation Clinic/Center 261QR0400X 2305002194 VA

Addresses

Primary practice location

10301 Democracy LN
Suite 100
Fairfax, VA 22030-2545

Mailing address

10301 Democracy LN
Suite 100
Fairfax, VA 22030-2545
Phone (703) 273-9191

Other identifiers 1

IdentifierTypeStateIssuer
4979184MedicaidVA

National Provider Directory

National Provider Directory

Locations

10301 Democracy Ln
Ste 100
Fairfax, VA 22030
Phone (703) 273-9191

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1285612283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 DEMOCRACY LN",
            "address_2": "SUITE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302545",
            "telephone_number": "703-273-9191",
            "fax_number": "703-273-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 DEMOCRACY LN",
            "address_2": "SUITE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302545",
            "telephone_number": "703-273-9191",
            "fax_number": "703-273-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX REHABILITATION, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_middle_name": "ROCHON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-273-9191",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "VA",
            "license": "2305001398",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "VA",
            "license": "2305002194",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4979184",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.