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General NPI Number Information
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NPI Number | 1598118838
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Entity Type | Organization
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Legal Business Name | ERIN LIVELY
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 6767 FOREST HILL AVE SUITE 115
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City | RICHMOND
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State | VA
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Zip | 23225-1856
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Country | US
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Telephone | 804-901-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 6767 FOREST HILL AVE SUITE 115
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City | RICHMOND
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State | VA
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Zip | 23225-1856
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Country | US
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Telephone | 804-901-2181
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Fax |
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Authorized Official
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Title or Position | BCMT/OWNER
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Name | ERIN D LIVELY
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Credential | BCMT, MMP
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Telephone | 804-901-2181
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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 | 0019004616
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License Number State | VA
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