Organization
PROACTIVE MASSAGE & BODYWORK, LLC
Active
Organization
PROACTIVE MASSAGE & BODYWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA GAIL HEAVNER LMT (OWNER)
(804) 559-7990
Entity
Organization
Contact information
Practice address
9291 LAUREL GROVE RD, MECHANICSVILLE, VA 23116-2969
(804) 559-7990
Mailing address
9031 FASCINE CT, MECHANICSVILLE, VA 23116-6570
(804) 559-7990
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019003993
—
VA
Enumeration date
12/03/2019
Last updated
12/03/2019
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