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NPI Code Detail

MEDICARE: SANTRICE LAFONDA CRAFTON C.M.T., M.M.P

MEDICARE: SANTRICE LAFONDA CRAFTON C.M.T., M.M.P
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
1225700000XMassage Therapist0019006069VA

General Provider Information

NPI Number : 1265750483
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANTRICE LAFONDA CRAFTON C.M.T., M.M.P
Provider Business Mailing Address
First Line : 1518 DECATUR ST
Second Line :
City : RICHMOND
State : VA
Zip : 23224-3822
Country : US
Telephone Number : 804-869-1799
Fax Number :
Provider Business Practice Location Address
First Line : 1518 WILLOW LAWN DR
Second Line : SUITE 319
City : RICHMOND
State : VA
Zip : 23230-3419
Country : US
Telephone Number : 804-869-1799
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2010
Last Update Date : 05/12/2010

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