| Reboot Functional Health Care Corporation | |
|
2528 Las Brisas Dr Virginia Beach VA 23456-4264 | |
| (757) 301-6985 | |
| Not Available |
| Full Name | Reboot Functional Health Care Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 2528 Las Brisas Dr, Virginia Beach, Virginia |
| Authorized Official Name and Position | Laurie Dierstein (OWNER/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7573016985 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reboot Functional Health Care Corporation 2528 Las Brisas Dr Virginia Beach VA 23456-4264 Ph: (757) 301-6985 | Reboot Functional Health Care Corporation 2528 Las Brisas Dr Virginia Beach VA 23456-4264 Ph: (757) 301-6985 |
| NPI Number | 1427709526 |
|---|---|
| Provider Enumeration Date | 01/11/2022 |
| Last Update Date | 01/11/2022 |
| Medicare PECOS PAC ID | 1052796604 |
|---|---|
| Medicare Enrollment ID | O20220916002781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427709526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary A Bjorkman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023296399 PECOS PAC ID: 4486725306 Enrollment ID: I20080620000372 |
| Provider Name | Lori S Palcic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427474014 PECOS PAC ID: 3779706981 Enrollment ID: I20140515001168 |
| Provider Name | Shannon Cantrice Thain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902386782 PECOS PAC ID: 2961734108 Enrollment ID: I20191021003509 |
| Provider Name | Joseph Hamilton Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306365051 PECOS PAC ID: 1759707144 Enrollment ID: I20200817000417 |
| Provider Name | Bethanie L Nice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205253580 PECOS PAC ID: 5294002176 Enrollment ID: I20201125000153 |
| Provider Name | Sharon Meyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427694033 PECOS PAC ID: 4385061316 Enrollment ID: I20230417002312 |
| Provider Name | Bradley Kevin Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336826692 PECOS PAC ID: 9335500123 Enrollment ID: I20230726001286 |
| Provider Name | Alyssa Mae Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093303786 PECOS PAC ID: 8628486354 Enrollment ID: I20230815003922 |
| Provider Name | Molly Girard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316689151 PECOS PAC ID: 6002264330 Enrollment ID: I20231128001540 |
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