Healthcare Provider Details

I. General information

NPI: 1538760491
Provider Name (Legal Business Name): CORTEX INITIATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 MOUNT PLEASANT RD STE 103
CHESAPEAKE VA
23322-3919
US

IV. Provider business mailing address

1457 MOUNT PLEASANT RD STE 103
CHESAPEAKE VA
23322-3919
US

V. Phone/Fax

Practice location:
  • Phone: 757-780-8146
  • Fax: 833-924-0333
Mailing address:
  • Phone: 757-780-8146
  • Fax: 833-924-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNE MARIE TAMBURELLO
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/OWNER
Credential: MS, CCC-SLP, CBIS
Phone: 757-409-3495