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General NPI Number Information
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NPI Number | 1811372675
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Entity Type | Organization
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Legal Business Name | ALTAVISTA MEDICAL & ONCOLOGY MASSAGE THERAPY
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 600 BROAD ST
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City | ALTAVISTA
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State | VA
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Zip | 24517-1852
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Country | US
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Telephone | 434-309-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 600 BROAD ST
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City | ALTAVISTA
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State | VA
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Zip | 24517-1852
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Country | US
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Telephone | 434-309-1775
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | SILVY LEE PERKINS
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Credential | CMT
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Telephone | 434-309-1775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 0019012447
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License Number State | VA
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