MEDICARE: KNIKEYA ROBINSON 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	0019009325	VA

General Provider Information

NPI Number	:	1396105789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KNIKEYA ROBINSON LMT

Provider Business Mailing Address
First Line	:	5269 GREENWICH RD
Second Line	:	101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6009
Country	:	US
Telephone Number	:	757-839-6404
Fax Number	:

Provider Business Practice Location Address
First Line	:	5269 GREENWICH RD
Second Line	:	101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6009
Country	:	US
Telephone Number	:	757-839-6404
Fax Number	:

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

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	02/29/2016

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