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General NPI Number Information
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NPI Number | 1700416609
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Entity Type | Organization
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Legal Business Name | FOREVER RELISHED
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 300 HICKMAN RD STE 301B
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-3554
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Country | US
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Telephone | 434-284-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 798 SQUIRE HILL CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-3304
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Country | US
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Telephone | 540-448-6200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES MCCRAY
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Credential |
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Telephone | 540-448-6200
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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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