MEDICARE: BOUNDLESS INC

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	171100000X	Acupuncturist	0121000449	VA

General Provider Information

NPI Number	:	1346537636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNDLESS INC

Provider Business Mailing Address
First Line	:	5269 GREENWICH RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6009
Country	:	US
Telephone Number	:	757-490-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	5269 GREENWICH RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6009
Country	:	US
Telephone Number	:	757-490-7555
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	MRS. VIVIANNE HIPOL GANTOUS
Credential	:	L.AC., DIPL.OM, RN
Telephone Number	:	757-490-7555

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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Directions to “BOUNDLESS INC ” Practice Location

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