MEDICARE: THE TEAL CENTER FOR THERAPEUTIC BODYWORK, LTD.

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	171100000X	Acupuncturist
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1447798046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE TEAL CENTER FOR THERAPEUTIC BODYWORK, LTD.

Provider Business Mailing Address
First Line	:	4001 9TH ST N
Second Line	:	STE 230
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1956
Country	:	US
Telephone Number	:	703-522-7637
Fax Number	:	703-522-2711

Provider Business Practice Location Address
First Line	:	4001 9TH ST N
Second Line	:	STE 230
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1956
Country	:	US
Telephone Number	:	703-522-7637
Fax Number	:	703-522-2711

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. BRENDA TEAL
Credential	:	LMT
Telephone Number	:	703-622-7800

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/03/2017

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