Healthcare Provider Details

I. General information

NPI: 1790546661
Provider Name (Legal Business Name): RESTORATIVE BALANCE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 OLD HUNDRED RD
CHESTER VA
23831-4232
US

IV. Provider business mailing address

PO BOX 2546
VIRGINIA BEACH VA
23450-2546
US

V. Phone/Fax

Practice location:
  • Phone: 804-813-0085
  • Fax: 888-571-2896
Mailing address:
  • Phone: 757-340-3489
  • Fax: 757-340-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CAITIE MONROE
Title or Position: CREDENTIALING SPECIA
Credential:
Phone: 757-340-3489