MEDICARE: BACK TO LIFE MASSAGE LLC

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

General Provider Information

NPI Number	:	1740120781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO LIFE MASSAGE LLC

Provider Business Mailing Address
First Line	:	3852 VIRGINIA BEACH BLVD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2489
Country	:	US
Telephone Number	:	757-402-3092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3852 VIRGINIA BEACH BLVD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2489
Country	:	US
Telephone Number	:	757-402-3092
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MASSAGE THERAPIST
Name	:	CYNTHIA DEL CARMEN THOMAS
Credential	:
Telephone Number	:	757-402-3092

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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Directions to “BACK TO LIFE MASSAGE LLC ” Practice Location

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