Basic Information
| Provider Information | |||||||||
| NPI: | 1447540430 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MILES MASSAGE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6058B ESSEX HOUSE SQ | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223104315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035825115 | ||||||||
| FaxNumber: | 2024502857 | ||||||||
| Practice Location | |||||||||
| Address1: | 6058B ESSEX HOUSE SQ | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223104315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035825115 | ||||||||
| FaxNumber: | 2024502857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARR | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7035825115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MT124 | DC | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225700000X | 0019002576 | VA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.