MEDICARE: NOVA THERAPEUTIC MASSAGE 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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1619807534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA THERAPEUTIC MASSAGE LTD

Provider Business Mailing Address
First Line	:	2250 CLARENDON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3332
Country	:	US
Telephone Number	:	202-374-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 CLARENDON BLVD STE K
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3349
Country	:	US
Telephone Number	:	703-816-8811
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAN DAVISON
Credential	:	LMT
Telephone Number	:	703-816-8811

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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