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
—
—
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
05/24/2024
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