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General NPI Number Information
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NPI Number | 1346880788
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Entity Type | Individual
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Provider Name | JULIENNE NASCIMENTO PEREZ MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 211A N 18TH ST # 2
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City | RICHMOND
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State | VA
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Zip | 23223-6905
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Country | US
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Telephone | 702-508-1506
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Fax |
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Provider Business Mailing Address
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Address Line | 8631 MILLSTREAM DR
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City | RICHMOND
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State | VA
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Zip | 23228-1795
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Country | US
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Telephone | 702-508-1506
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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 | 0019013425
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License Number State | VA
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