Provider Demographics
NPI:1619240033
Name:BEST LIFE PHYSICAL THERAPY AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:BEST LIFE PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-748-6003
Mailing Address - Street 1:2404 POTTERS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4335
Mailing Address - Country:US
Mailing Address - Phone:757-961-5888
Mailing Address - Fax:757-961-5888
Practice Address - Street 1:2404 POTTERS RD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4335
Practice Address - Country:US
Practice Address - Phone:757-961-5888
Practice Address - Fax:757-340-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052072302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty