Healthcare Provider Details

I. General information

NPI: 1013732833
Provider Name (Legal Business Name): VIRGINIA PAIN AND RESTORATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3781 WESTERRE PKWY STE E
RICHMOND VA
23233-1328
US

IV. Provider business mailing address

2924 GLEN GARY DR
HENRICO VA
23233-7703
US

V. Phone/Fax

Practice location:
  • Phone: 804-461-3637
  • Fax: 804-847-4813
Mailing address:
  • Phone: 610-517-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TINA DAILEY
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 610-517-6160