Provider Demographics
NPI:1235411810
Name:GREEN VI LLC
Entity Type:Organization
Organization Name:GREEN VI LLC
Other - Org Name:VITALITY PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REINBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-745-4787
Mailing Address - Street 1:9100 HAVENSIGHT
Mailing Address - Street 2:PORT OF SALE, STE 15-16
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9100 HAVENSIGHT
Practice Address - Street 2:PORT OF SALE, STE 15-16
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:310-745-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI164261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy