Healthcare Provider Details

I. General information

NPI: 1558539460
Provider Name (Legal Business Name): BARBARA DIANE EMORY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 WELLINGTON RD
COLONIAL HEIGHTS VA
23834-2739
US

IV. Provider business mailing address

27 BOLLINGBROOK ST 2ND FLOOR
PETERSBURG VA
23803-4548
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-0252
  • Fax: 804-722-1721
Mailing address:
  • Phone: 804-722-1720
  • Fax: 804-722-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA14565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: