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General NPI Number Information
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NPI Number | 1235526070
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Entity Type | Organization
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Legal Business Name | REHABILITATIVE CONNECTIONS
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 2105 ELECTRIC RD SUITE 103
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City | ROANOKE
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State | VA
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Zip | 24018-2315
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Country | US
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Telephone | 540-400-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 ELECTRIC RD SUITE 103
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City | ROANOKE
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State | VA
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Zip | 24018-2315
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Country | US
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Telephone | 540-400-0004
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. LOVE KINGSBURY
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Credential | CMT
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Telephone | 540-400-0004
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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 | 0019012842
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License Number State | VA
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