Organization
CENTER FOR NEUROREHABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VAN WILLIAM LUETHKE (ADMINISTRATOR)
(804) 272-0114
Entity
Organization
Contact information
Practice address
7401 BEAUFONT SPRINGS DR, SUITE 205, NORTH CHESTERFIELD, VA 23225-5520
(804) 272-0114
(804) 272-1125
Mailing address
7401 BEAUFONT SPRINGS DR, SUITE 205, NORTH CHESTERFIELD, VA 23225-5520
(804) 272-0114
(804) 272-1125
Taxonomy
Speciality
Code
Description
License number
State
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
Primary
0101036956
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350504800
DOL PROVIDER NUMBER
VA
Enumeration date
02/06/2007
Last updated
05/11/2023
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