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General NPI Number Information
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NPI Number | 1144974841
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Entity Type | Organization
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Legal Business Name | MASSAGE BY RAVEN (MOBILE, CLINICAL, MASSAGE)
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 732 EDEN WAY NORTH SUITE E
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2798
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Country | US
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Telephone | 757-453-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 732 EDEN WAY N STE E
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2798
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Country | US
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Telephone | 757-453-5513
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST/OWNER
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Name | RAVEN WALKER
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Credential | MT
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Telephone | 757-453-5513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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