MEDICARE: JIMMY VO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1003596719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMMY VO, LLC

Provider Business Mailing Address
First Line	:	1500 W 41ST ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 W 41ST ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3325
Country	:	US
Telephone Number	:	781-632-1780
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JIMMY VO
Credential	:	PT, DPT
Telephone Number	:	781-632-1780

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/19/2023

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Directions to “JIMMY VO, LLC ” Practice Location

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