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General NPI Number Information
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NPI Number | 1831565902
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Entity Type | Individual
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Provider Name | LISA BIVENS LMT
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Gender | Female
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1310 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-5219
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Country | US
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Telephone | 540-797-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 1268 FLYING W LN
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City | VINTON
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State | VA
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Zip | 24179-5726
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Country | US
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Telephone | 540-797-5851
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Fax | 540-369-6261
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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 | 0019010885
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License Number State | VA
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