Healthcare Provider Details

I. General information

NPI: 1164386082
Provider Name (Legal Business Name): ASHLEY JUSTINIANO CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 CEDAR LAKES DR STE 101
CHESAPEAKE VA
23322-8380
US

IV. Provider business mailing address

4621 WINDERMERE AVE
NORFOLK VA
23513-5428
US

V. Phone/Fax

Practice location:
  • Phone: 757-546-0031
  • Fax: 757-482-9379
Mailing address:
  • Phone: 757-581-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019014944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: