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General NPI Number Information
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NPI Number | 1366080467
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Entity Type | Organization
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Legal Business Name | MOBILITY SPA LLC
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 2300 N PERSHING DR STE 201
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City | ARLINGTON
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State | VA
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Zip | 22201-1428
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Country | US
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Telephone | 703-646-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 2 CANTERBURY SQ APT 302
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3049
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Country | US
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Telephone | 703-965-6802
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER/LMT
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Name | MS. AMANDA LUIZA SILVA
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Credential | LMT
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Telephone | 703-965-6802
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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 |
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License Number State |
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