Healthcare Provider Details

I. General information

NPI: 1629473681
Provider Name (Legal Business Name): JUST RELAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2014
Last Update Date: 11/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9363 SCARLET OAK DR
MANASSAS VA
20110-5669
US

IV. Provider business mailing address

9363 SCARLET OAK DR
MANASSAS VA
20110-5669
US

V. Phone/Fax

Practice location:
  • Phone: 703-850-2310
  • Fax:
Mailing address:
  • Phone: 703-850-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019001640
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JEANNIE WALKER
Title or Position: OWNER
Credential:
Phone: 703-850-2310