# REBOOT FUNCTIONAL HEALTH CARE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427709526
- **Authorized official:** MS. LAURIE DIERSTEIN (OWNER/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (757) 301-6985

## Contact information

- **Practice address:** 2528 LAS BRISAS DR, VIRGINIA BEACH, VA 23456-4264
- **Practice address phone:** (757) 301-6985
- **Mailing address:** 2528 LAS BRISAS DR, VIRGINIA BEACH, VA 23456-4264
- **Mailing address phone:** (757) 301-6985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/11/2022
- **Last updated:** 01/11/2022