MEDICARE: KEITH HOWARD MCBRIDE 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	0019013542	VA

General Provider Information

NPI Number	:	1780322685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH HOWARD MCBRIDE LMT

Provider Business Mailing Address
First Line	:	3740 VIRGINIUS DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3510
Country	:	US
Telephone Number	:	815-535-8765
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 VIRGINIA BEACH BLVD STE 203
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3993
Country	:	US
Telephone Number	:	815-535-8765
Fax Number	:

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

Provider Enumeration Date	:	05/22/2022
Last Update Date	:	05/22/2022

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Directions to “ KEITH HOWARD MCBRIDE LMT” Practice Location

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