Healthcare Provider Details

I. General information

NPI: 1437806429
Provider Name (Legal Business Name): GEORGE ROVDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 9TH ST N STE 219
ARLINGTON VA
22203-1954
US

IV. Provider business mailing address

720 N EDISON ST
ARLINGTON VA
22203-1433
US

V. Phone/Fax

Practice location:
  • Phone: 703-956-0566
  • Fax:
Mailing address:
  • Phone: 703-956-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019008652
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: