Provider Demographics
NPI:1952866659
Name:HERBERT, LORRIN AVERY (CFO)
Entity Type:Individual
Prefix:
First Name:LORRIN
Middle Name:AVERY
Last Name:HERBERT
Suffix:
Gender:M
Credentials:CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 INVESTORS PL STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1171
Mailing Address - Country:US
Mailing Address - Phone:757-275-8050
Mailing Address - Fax:888-600-5328
Practice Address - Street 1:404 INVESTORS PL STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1171
Practice Address - Country:US
Practice Address - Phone:757-275-8050
Practice Address - Fax:888-600-5328
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACFO04815225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter