Healthcare Provider Details

I. General information

NPI: 1336696491
Provider Name (Legal Business Name): PIER 6 THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 6TH STREET
IRON GATE VA
24448
US

IV. Provider business mailing address

P.O. BOX 32
IRON GATE VA
24448
US

V. Phone/Fax

Practice location:
  • Phone: 540-784-3424
  • Fax:
Mailing address:
  • Phone: 540-784-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019014103
License Number StateVA

VIII. Authorized Official

Name: MRS. KATELYNNE ELIZABETH MASON
Title or Position: MASSAGE THERAPIST
Credential: CMT
Phone: 540-784-3424