Healthcare Provider Details

I. General information

NPI: 1366651754
Provider Name (Legal Business Name): VALLEY PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

IV. Provider business mailing address

1934 BRAEBURN DR
SALEM VA
24153-7302
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0253
  • Fax: 540-982-1996
Mailing address:
  • Phone: 540-982-0253
  • Fax: 540-982-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000859
License Number StateVA

VIII. Authorized Official

Name: DR. PINK P WIMBISH III
Title or Position: OWNER
Credential: DPM
Phone: 540-982-0253