Organization
COLLEGE SPORTS REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEIRON ALLEN HOLMES PT, DPT, SCS (CO-OWNER)
(703) 314-9891
Entity
Organization
Contact information
Practice address
1301 COLLEGE AVE, GOOLRICK HALL ATHLETIC TRAINING ROOM (ROOM 102), FREDERICKSBURG, VA 22401-5300
(703) 314-9891
Mailing address
15597 HORSESHOE LN, WOODBRIDGE, VA 22191-4128
(703) 314-9891
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2305205379
VA
261QP2000X
Physical Therapy Clinic/Center
870876
DC
Other
Enumeration date
06/27/2012
Last updated
06/27/2012
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