Healthcare Provider Details

I. General information

NPI: 1639884414
Provider Name (Legal Business Name): ENRICH YOUR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 FITZHUGH AVE
RICHMOND VA
23230-3827
US

IV. Provider business mailing address

4110 FITZHUGH AVE
RICHMOND VA
23230-3827
US

V. Phone/Fax

Practice location:
  • Phone: 804-380-1316
  • Fax:
Mailing address:
  • Phone: 804-380-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL COLES
Title or Position: OWNER/ HOLISTIC HEALTH PRACTITIONER
Credential: CMT,CES
Phone: 804-380-1316