Organization Name: | NEW RIVER MEDICCAL MASSAGE |
NPI Number: | 1194105247 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT ERNEST WALLACE (OWNER/THERAPIST) |
Mailing Address: | 319 W Main St Radford |
State: | VA US |
Postal Code: | 241411586 |
Phone Number: | 5406333828 |
Fax Number: | 5406333829 |
NPI Enumeration Date: | 06/04/2015 |
NPI Last Update Date: | 06/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 0019001695 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |