MEDICARE: MRS. TALLIE FROST

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	0019019455	VA

General Provider Information

NPI Number	:	1841070729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TALLIE FROST

Provider Business Mailing Address
First Line	:	1805 OLD RIDGE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6813
Country	:	US
Telephone Number	:	757-354-5448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 OLD RIDGE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6813
Country	:	US
Telephone Number	:	757-354-5448
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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Directions to “ MRS. TALLIE FROST ” Practice Location

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