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General NPI Number Information
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NPI Number | 1336529171
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Entity Type | Individual
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Provider Name | KRISTOPHER KEARNEY
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Gender | Male
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Dates
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Enumeration Date | 06/07/2015
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Last Update Date | 06/07/2015
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Provider Practice Location Address
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Address Line | 2807 NEIL DR
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City | ROANOKE
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State | VA
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Zip | 24019-3411
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Country | US
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Telephone | 540-355-8120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | SALEM
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State | VA
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Zip | 24153-0262
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Country | US
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Telephone |
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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 | 0019012429
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License Number State | VA
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