Healthcare Provider Details

I. General information

NPI: 1447540430
Provider Name (Legal Business Name): MILES MASSAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6058B ESSEX HOUSE SQ
ALEXANDRIA VA
22310-4315
US

IV. Provider business mailing address

6058B ESSEX HOUSE SQ
ALEXANDRIA VA
22310-4315
US

V. Phone/Fax

Practice location:
  • Phone: 703-582-5115
  • Fax: 202-450-2857
Mailing address:
  • Phone: 703-582-5115
  • Fax: 202-450-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT124
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019002576
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW L. CARR
Title or Position: OWNER
Credential:
Phone: 703-582-5115