MEDICARE: JESUS JAVIER ANDINO-AQUINO CMT, LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019002651	VA

General Provider Information

NPI Number	:	1144076811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS JAVIER ANDINO-AQUINO CMT, LMT

Provider Business Mailing Address
First Line	:	8131 GIDEONS LN
Second Line	:
City	:	JEFFERSONTON
State	:	VA
Zip	:	22724-2366
Country	:	US
Telephone Number	:	703-967-7506
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 WATERLOO ST STE 212
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-3238
Country	:	US
Telephone Number	:	703-967-7506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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