MEDICARE: MALIK VANTERPOOL

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	MT1206	DC

General Provider Information

NPI Number	:	1275949513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIK VANTERPOOL

Provider Business Mailing Address
First Line	:	PO BOX 100382
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22210-3382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 WADE RD SE APT 11
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5906
Country	:	US
Telephone Number	:	202-302-4081
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/08/2014

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Directions to “ MALIK VANTERPOOL ” Practice Location

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