=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154207272
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCOS ADELMO BERRIOS RODRIGUEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2025
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 MONTGOMERY CIR
-----------------------------------------------------
City | STEPHENS CITY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22655-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-877-0765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 MONTGOMERY CIR
-----------------------------------------------------
City | STEPHENS CITY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22655-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-877-0765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 0019019692
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------