Provider Demographics
NPI:1689418550
Name:THE SOURCE PELVIC HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:THE SOURCE PELVIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-572-5757
Mailing Address - Street 1:2380 LIBERTY WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3466
Mailing Address - Country:US
Mailing Address - Phone:757-932-8977
Mailing Address - Fax:757-932-8979
Practice Address - Street 1:2380 LIBERTY WAY STE 2
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3466
Practice Address - Country:US
Practice Address - Phone:757-932-8977
Practice Address - Fax:757-932-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy