Organization
PERFECT STORM
Active
Organization
PERFECT STORM
Active
Other names
PS Contouring, Perfect Storm Body Contouring
Organization subpart
No
Provider details
NPI number
Authorized official
MONDERRAY BLASSINGAME (COO)
(703) 388-9073
Entity
Organization
Contact information
Practice address
6800 FLEETWOOD RD STE 110, MC LEAN, VA 22101-3604
(703) 388-9073
Mailing address
6800 FLEETWOOD RD STE 110, MC LEAN, VA 22101-3604
(703) 388-9073
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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