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General NPI Number Information
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NPI Number | 1285209494
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Entity Type | Organization
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Legal Business Name | TRANQUIL ASSUAGE
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 505 FAULCONER DR STE 2B
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4981
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Country | US
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Telephone | 434-328-6163
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Fax | 434-296-5433
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Provider Business Mailing Address
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Address Line | PO BOX 695
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City | CROZET
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State | VA
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Zip | 22932-0695
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Country | US
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Telephone | 434-328-6163
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Fax | 434-296-5433
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Authorized Official
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Title or Position | OWNER
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Name | DONNA F SANDRIDGE-WALKER
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Credential | NBCMT, LMT, MMP
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Telephone | 434-328-6163
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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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