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General NPI Number Information
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NPI Number | 1730801911
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Entity Type | Organization
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Legal Business Name | KUNG FU MASSAGE LLC
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 20755 WILLIAMSPORT PL STE 200
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City | ASHBURN
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State | VA
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Zip | 20147-6524
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Country | US
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Telephone | 703-623-3417
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Fax |
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Provider Business Mailing Address
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Address Line | 20755 WILLIAMSPORT PL STE 200
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City | ASHBURN
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State | VA
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Zip | 20147-6524
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Country | US
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Telephone | 703-623-3417
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BENJAMIN REDLIN
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Credential |
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Telephone | 703-623-3417
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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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