Provider Demographics
NPI:1962211011
Name:LONGEVITY INSTITUTE OF VIRGINIA
Entity type:Organization
Organization Name:LONGEVITY INSTITUTE OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-219-2873
Mailing Address - Street 1:2412 CAMINO REAL S
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4242
Mailing Address - Country:US
Mailing Address - Phone:619-822-9571
Mailing Address - Fax:
Practice Address - Street 1:2236 GENERAL BOOTH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4092
Practice Address - Country:US
Practice Address - Phone:757-219-2873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy