College Sports Rehab

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2305205379 Issued in VA

Legal business name

COLLEGE SPORTS REHAB

Practice address

1301 College Ave
Goolrick Hall Athletic Training Room (Room 102)
Fredericksburg, VA 22401-5300

Phone

(703) 314-9891

NPI assigned

Jun 27, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Keiron Allen Holmes, PT, DPT, SCS

Title

Co-Owner

Phone

(703) 314-9891

Specialties & licenses 2

Addresses

Tax ID family

College Sports Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• DMV Sports Medicine Institute

  • Physical Therapy Clinic/Center
  • Woodbridge, VA
  • NPI 1801282652
  NPD tax ID

Locations

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340755200000",
    "number": "1376807065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15597 HORSESHOE LN",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914128",
            "telephone_number": "703-314-9891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 COLLEGE AVE",
            "address_2": "GOOLRICK HALL ATHLETIC TRAINING ROOM (ROOM 102)",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015300",
            "telephone_number": "703-314-9891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE SPORTS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-27",
        "last_updated": "2012-06-27",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "KEIRON",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "703-314-9891",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT, SCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "VA",
            "license": "2305205379",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "DC",
            "license": "870876",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albertina Coleman, PHARM.D.
• Ashley Coleman, PHARMD
• Brittney Coleman, M.S.
• Cynthia Coleman, MSW
• William P. Coleman, M.D.
• Cheyenne Nichole Colley, CRNA
• Robert Patrick Colligan, MD
• Irene K Colling
• Anthony. Wayne Collins Sr.
• Beth L Collins, LCSW

• Physical Therapy Clinic/Center in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Physical Therapy Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; 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.