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General NPI Number Information
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NPI Number | 1295413334
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Entity Type | Organization
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Legal Business Name | GLACIER CHILL ONSITE & MOBILE CRYOTHERAPY
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 13455 SUNRISE VALLEY DR UNIT 2016
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City | HERNDON
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State | VA
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Zip | 20171-3392
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Country | US
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Telephone | 859-382-2009
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Fax |
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Provider Business Mailing Address
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Address Line | 13455 SUNRISE VALLEY DR UNIT 2016
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City | HERNDON
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State | VA
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Zip | 20171-3392
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Country | US
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Telephone | 859-382-2009
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DARREN PRICE
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Credential |
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Telephone | 859-382-2009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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