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General NPI Number Information
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NPI Number | 1568212546
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Entity Type | Individual
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Provider Name | PARKER LOESCH
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Gender | Male
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 12042 W BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23233-7689
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Country | US
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Telephone | 804-251-3915
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Fax |
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Provider Business Mailing Address
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Address Line | 3153 ELLWOOD AVE APT C
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City | RICHMOND
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State | VA
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Zip | 23221-2926
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Country | US
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Telephone | 316-680-8640
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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 | 0019018852
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License Number State | VA
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