MEDICARE: AVA TOWN

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	225700000X	Massage Therapist	0019020814	VA

General Provider Information

NPI Number	:	1144163429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA TOWN

Provider Business Mailing Address
First Line	:	3852 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2489
Country	:	US
Telephone Number	:	757-402-3092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3852 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23452-2489
Country	:	US
Telephone Number	:	757-402-3092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ AVA TOWN ” Practice Location

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