Healthcare Provider Details

I. General information

NPI: 1831268168
Provider Name (Legal Business Name): LORRIE ANNE WITCHER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 AMT TECH DR # S202
ROCKY MOUNT VA
24151-6735
US

IV. Provider business mailing address

180 AMT TECH DR S202
ROCKY MOUNT VA
24151-6696
US

V. Phone/Fax

Practice location:
  • Phone: 540-489-4263
  • Fax:
Mailing address:
  • Phone: 540-489-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019005849
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: