MEDICARE: CAROLYN JO PERRY

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	0019007848	VA

General Provider Information

NPI Number	:	1629885546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN JO PERRY

Provider Business Mailing Address
First Line	:	3168 MAGIC HOLLOW BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3011
Country	:	US
Telephone Number	:	757-304-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3168 MAGIC HOLLOW BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3011
Country	:	US
Telephone Number	:	757-270-6449
Fax Number	:

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

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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Directions to “ CAROLYN JO PERRY ” Practice Location

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