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General NPI Number Information
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NPI Number | 1336696491
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Entity Type | Organization
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Legal Business Name | PIER 6 THERAPY LLC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 303 6TH STREET
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City | IRON GATE
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State | VA
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Zip | 24448
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Country | US
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Telephone | 540-784-3424
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 32
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City | IRON GATE
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State | VA
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Zip | 24448
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Country | US
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Telephone | 540-784-3424
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MRS. KATELYNNE ELIZABETH MASON
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Credential | CMT
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Telephone | 540-784-3424
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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 | 0019014103
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License Number State | VA
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