MEDICARE: ENTIRE RECOVERY BODYWORKS, 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	:	1952058539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTIRE RECOVERY BODYWORKS, LLC

Provider Business Mailing Address
First Line	:	604 SUGARLAND RUN DR
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-1115
Country	:	US
Telephone Number	:	571-245-4638
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 SUGARLAND RUN DR
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-1115
Country	:	US
Telephone Number	:	571-245-4638
Fax Number	:

Authorized Official
Title or Position	:	MASSAGE THERAPIST
Name	:	GIANINA ISABEL VEGA
Credential	:	MMP, LMT, CMT
Telephone Number	:	571-245-4638

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	03/22/2022

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