Organization
SPORT & SPINE REHAB OF STERLING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAWANDA HACKLEY (MANGER)
(240) 766-0300
Entity
Organization
Contact information
Practice address
46440 BENEDICT DR, STE 106, STERLING, VA 20164-6602
(240) 766-0300
(240) 766-0304
Mailing address
11418 LIVINGSTON RD, FT WASHINGTON, MD 20744-5145
(240) 766-0300
(240) 766-0304
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104556518
VA
111N00000X
Chiropractor
0104556529
VA
111NR0200X
Radiology Chiropractor
0104556518
VA
111NR0400X
Rehabilitation Chiropractor
0104556529
VA
Other
Enumeration date
09/27/2007
Last updated
09/27/2007
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