Healthcare Provider Details

I. General information

NPI: 1801201827
Provider Name (Legal Business Name): SINCERE TOUCH MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W JEFFERSON ST
FALLS CHURCH VA
22046-3417
US

IV. Provider business mailing address

3560 MALVERN ST APT 123
WALDORF MD
20603-7210
US

V. Phone/Fax

Practice location:
  • Phone: 240-222-2377
  • Fax:
Mailing address:
  • Phone: 240-222-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0019012152
License Number StateVA

VIII. Authorized Official

Name: MR. CARL ERIC NELSON
Title or Position: MASSAGE THERAPIST
Credential: NMT
Phone: 240-222-2377