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General NPI Number Information
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NPI Number | 1477927077
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Entity Type | Organization
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Legal Business Name | RECOUP MASSAGE LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 12734 DULCINEA PL
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City | WOODBRIDGE
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State | VA
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Zip | 22192-3122
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Country | US
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Telephone | 571-336-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 12734 DULCINEA PL
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City | WOODBRIDGE
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State | VA
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Zip | 22192-3122
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Country | US
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Telephone | 571-336-6113
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/OPERATOR
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Name | NICHOLE D WEBB
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Credential | CMT
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Telephone | 215-900-4661
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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 | 15L04582
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License Number State | VA
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