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General NPI Number Information
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NPI Number | 1730939331
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Entity Type | Organization
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Legal Business Name | CRYSTAL MASSAGE SPA
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 102 ELDEN ST STE 18
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City | HERNDON
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State | VA
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Zip | 20170-4839
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Country | US
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Telephone | 571-352-4502
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Fax |
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Provider Business Mailing Address
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Address Line | 102 ELDEN ST STE 18
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City | HERNDON
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State | VA
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Zip | 20170-4839
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Country | US
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Telephone | 571-352-4502
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MIN SHI
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Credential |
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Telephone | 571-352-4502
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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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