MEDICARE: BAIGALMAA BAGI DAGVA

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	0019010729	VA

General Provider Information

NPI Number	:	1518785997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAIGALMAA BAGI DAGVA

Provider Business Mailing Address
First Line	:	311 MAPLE AVE W
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4309
Country	:	US
Telephone Number	:	703-242-3610
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MAPLE AVE W
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4309
Country	:	US
Telephone Number	:	703-242-3610
Fax Number	:

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

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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