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General NPI Number Information
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NPI Number | 1578229449
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Entity Type | Organization
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Legal Business Name | MICAIAH SARAI, LLC
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 713 N COURTHOUSE RD. STE 100
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City | N. CHESTERFIELD
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State | VA
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Zip | 23236-4074
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Country | US
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Telephone | 804-994-3269
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Fax |
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Provider Business Mailing Address
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Address Line | 713 N COURTHOUSE RD. STE 100
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City | N. CHESTERFIELD
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State | VA
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Zip | 23236-4074
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Country | US
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Telephone | 804-994-3269
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. MELISSA ELLEN DEATON
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Credential | MMP, LMT
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Telephone | 804-994-3269
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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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