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General NPI Number Information
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NPI Number | 1316559826
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Entity Type | Individual
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Provider Name | JUAN DEL RISCO MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 1108 K ST NW
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City | WASHINGTON
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State | DC
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Zip | 20005-4066
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Country | US
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Telephone | 120-234-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 4831 JAY ST NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3755
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Country | US
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Telephone | 202-460-6819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MT1732
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License Number State | DC
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