# REACH PEDIATRIC REHAB

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Reach Pediatric Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770225674
- **Authorized official:** DR. KELLY LORAINE DAUER PHAM MD (OWNER)
- **Authorized official phone:** (571) 310-2502

## Contact information

- **Practice address:** 8229 BOONE BLVD STE 260, VIENNA, VA 22182-2661
- **Practice address phone:** (571) 310-2502
- **Practice address fax:** (571) 413-0290
- **Mailing address:** 8229 BOONE BLVD STE 260, VIENNA, VA 22182-2661
- **Mailing address phone:** (571) 310-2502
- **Mailing address fax:** (571) 413-0290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | NULL | Yes |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2022
- **Last updated:** 05/24/2024