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General NPI Number Information
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NPI Number | 1346135019
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Entity Type | Individual
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Provider Name | DANAE MARINELLY DOMINGUEZ ALVAREZ MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 14801 MURDOCK ST
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City | CHANTILLY
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State | VA
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Zip | 20151-1037
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Country | US
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Telephone | 571-551-8304
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Fax |
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Provider Business Mailing Address
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Address Line | 15742 WIDEWATER DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1212
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Country | US
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Telephone | 571-296-8518
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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 | 0019017947
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License Number State | VA
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