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Organization
REACH PEDIATRIC REHAB
Active
Organization
REACH PEDIATRIC REHAB
Active
Other names
Reach Pediatric Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY LORAINE DAUER PHAM MD (OWNER)
(571) 310-2502
Entity
Organization
Contact information
Practice address
8229 BOONE BLVD STE 260, VIENNA, VA 22182-2661
(571) 310-2502
(571) 413-0290
Mailing address
8229 BOONE BLVD STE 260, VIENNA, VA 22182-2661
(571) 310-2502
(571) 413-0290
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
—
NULL
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
05/24/2024
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