Healthcare Provider Details

I. General information

NPI: 1851207773
Provider Name (Legal Business Name): JULIAN M KELLERMAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GENERAL BOOTH BLVD STE 100A
VIRGINIA BEACH VA
23454-5609
US

IV. Provider business mailing address

1253 NIMMO PKWY STE 110
VIRGINIA BEACH VA
23456-7782
US

V. Phone/Fax

Practice location:
  • Phone: 757-689-3113
  • Fax: 757-689-3702
Mailing address:
  • Phone: 757-918-7761
  • Fax: 757-689-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: