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General NPI Number Information
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NPI Number | 1871037689
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Entity Type | Organization
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Legal Business Name | YOUNG MEN'S CHRISTIAN ASSOCIATION AT VA POLYTECHNIC INST. & STATE UNI.
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 403 WASHINGTON ST SW
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City | BLACKSBURG
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State | VA
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Zip | 24060-4747
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Country | US
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Telephone | 540-961-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 403 WASHINGTON ST SW
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City | BLACKSBURG
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State | VA
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Zip | 24060-4747
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Country | US
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Telephone | 540-961-9622
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RYAN MARTIN
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Credential |
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Telephone | 540-961-9622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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