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General NPI Number Information
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NPI Number | 1629943469
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Entity Type | Organization
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Legal Business Name | ABC COLONIC WELLNESS
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 4810 BEAUREGARD ST
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1737
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Country | US
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Telephone | 703-261-9611
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Fax |
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Provider Business Mailing Address
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Address Line | 3313 CAMPBELL DR
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | CATALINA GOMEZ
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Credential | THERAPIST
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Telephone | 703-261-9611
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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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