Healthcare Provider Details

I. General information

NPI: 1336079235
Provider Name (Legal Business Name): BALLSTON THERAPEUTIC MASSAGE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N RANDOLPH ST STE 120
ARLINGTON VA
22203-4024
US

IV. Provider business mailing address

850 N RANDOLPH ST STE 120
ARLINGTON VA
22203-4024
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-3633
  • Fax:
Mailing address:
  • Phone: 703-558-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LING LIU
Title or Position: OWNER
Credential: LMT
Phone: 703-558-3633