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Organization
PAVILION OUTPATIENT THERAPY LLC
Active
Organization
PAVILION OUTPATIENT THERAPY LLC
Active
Parent organization
PAVILION MEDICAL HOME CARE & STAFFING, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PAVILION MEDICAL HOME CARE & STAFFING, LLC
Authorized official
GIBSON ERHUNMWUNSE CRNP (CEO)
(703) 299-9898
Entity
Organization
Contact information
Practice address
4115 ANNANDALE RD STE 202, ANNANDALE, VA 22003-2500
(703) 299-9898
(703) 299-9595
Mailing address
4115 ANNANDALE RD STE 202, ANNANDALE, VA 22003-2500
(703) 299-9898
(703) 299-9595
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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