Healthcare Provider Details

I. General information

NPI: 1639035330
Provider Name (Legal Business Name): SCORPION COVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 PARLIAMENT DR STE 104A
VA BEACH VA
23462-3300
US

IV. Provider business mailing address

5541 PARLIAMENT DR STE 104
VA BEACH VA
23462-3300
US

V. Phone/Fax

Practice location:
  • Phone: 757-281-8408
  • Fax:
Mailing address:
  • Phone: 757-281-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KYSHARA MILES
Title or Position: OWNER
Credential:
Phone: 757-281-8408