Healthcare Provider Details

I. General information

NPI: 1225948839
Provider Name (Legal Business Name): LYNDON SMITH KISSINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 LASKIN RD
VIRGINIA BEACH VA
23454-4558
US

IV. Provider business mailing address

121 VERA CRUZ RD APT A
VIRGINIA BEACH VA
23451-8171
US

V. Phone/Fax

Practice location:
  • Phone: 757-374-6210
  • Fax:
Mailing address:
  • Phone: 757-374-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019019977
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: