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General NPI Number Information
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NPI Number | 1912155425
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Entity Type | Individual
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Provider Name | IVONE CORVALAN OSBORNE CMT
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 8550 ARLINGTON BLVD STE 325
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City | FAIRFAX
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State | VA
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Zip | 22031-4647
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Country | US
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Telephone | 703-698-7117
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Fax | 703-698-5729
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Provider Business Mailing Address
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Address Line | 11441 FOGARTY CT
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City | FAIRFAX
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State | VA
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Zip | 22030-8555
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Country | US
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Telephone | 240-476-8224
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Fax | 703-272-7579
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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 | 0019005149
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License Number State | VA
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