Organization
MVP FITNESS AND MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIK VANTERPOOL (CEO)
(202) 302-4081
Entity
Organization
Contact information
Practice address
11604 BRONCO CT, UPPER MARLBORO, MD 20772-2985
(202) 302-4081
Mailing address
11604 BRONCO CT, UPPER MARLBORO, MD 20772-2985
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
225700000X
Massage Therapist
Primary
—
—
225800000X
Recreation Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045878800
—
DC
Enumeration date
02/28/2018
Last updated
02/28/2018
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