Healthcare Provider Details

I. General information

NPI: 1083480651
Provider Name (Legal Business Name): VIM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 SOUTHLEAF DR
VIRGINIA BEACH VA
23462-4749
US

IV. Provider business mailing address

752 SOUTHLEAF DR
VIRGINIA BEACH VA
23462-4749
US

V. Phone/Fax

Practice location:
  • Phone: 757-222-2230
  • Fax: 757-227-5460
Mailing address:
  • Phone: 757-222-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW FIANO
Title or Position: MANAGER
Credential: PT, DPT, OCS
Phone: 757-222-2230