Healthcare Provider Details

I. General information

NPI: 1376467142
Provider Name (Legal Business Name): RODERICK PICKENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 COLUMBIA PIKE APT 419
ARLINGTON VA
22204-1593
US

IV. Provider business mailing address

3400 COLUMBIA PIKE APT 419
ARLINGTON VA
22204-1593
US

V. Phone/Fax

Practice location:
  • Phone: 619-622-2651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019021033
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: