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Organization

NEW RIVER MEDICCAL MASSAGE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT ERNEST WALLACE MASSAGE THERAPIST (OWNER/THERAPIST)
(540) 633-3828
Entity
Organization

Contact information

Practice address
319 W MAIN ST, RADFORD, VA 24141-1586
(540) 633-3828
(540) 633-3829
Mailing address
319 WEST MAIN STREET, RADFORD, VA 24301
(540) 633-3828
(540) 633-3829

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0019001695
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
225700000X
MASSAGE THERAPY
VA
Enumeration date
06/04/2015
Last updated
06/04/2015
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