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General NPI Number Information
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NPI Number | 1255889226
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Entity Type | Organization
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Legal Business Name | MARYLAND MASSAGE THERAPY CENTER, LLC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 8301 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20814-3103
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Country | US
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Telephone | 301-913-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 8301 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20814-3103
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Country | US
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Telephone | 301-913-0345
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Fax |
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Authorized Official
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Title or Position | OWNER/ MASSAGE THERAPIST
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Name | MRS. TATIANA MICHELLE TCHAMOUROFF
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Credential | CMT
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Telephone | 301-913-0345
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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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