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
(202) 302-4081
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
225100000X
Physical Therapist
—
—
2255A2300X
Athletic Trainer
—
—
225700000X
Massage Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045878800
—
DC
Enumeration date
12/13/2017
Last updated
03/12/2018
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