Healthcare Provider Details

I. General information

NPI: 1457216046
Provider Name (Legal Business Name): DAVID SEA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ROANOKE BLVD STE 2
SALEM VA
24153-5033
US

IV. Provider business mailing address

511 ROANOKE BLVD STE 2
SALEM VA
24153-5033
US

V. Phone/Fax

Practice location:
  • Phone: 540-328-5858
  • Fax:
Mailing address:
  • Phone: 540-328-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019016246
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: