Individual
RAIWAT CHANCHAIVIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6303 BREN MAR DR, ALEXANDRIA, VA 22312-6342
(703) 477-8988
Mailing address
6303 BREN MAR DR, ALEXANDRIA, VA 22312-6342
(703) 477-8988
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019011228
VA
Other
Enumeration date
06/23/2023
Last updated
06/23/2023
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