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General NPI Number Information
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NPI Number | 1831054352
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Entity Type | Individual
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Provider Name | MINA CANTU MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 4300 PLANK RD STE 120
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-0102
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Country | US
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Telephone | 540-412-6536
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Fax | 540-252-0012
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Provider Business Mailing Address
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Address Line | 17308 CAMELLIA DR
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City | RUTHER GLEN
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State | VA
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Zip | 22546-4806
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Country | US
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Telephone | 540-412-6536
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Fax | 540-252-0012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0019019222
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License Number State |
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