NPI 1417722091

Si N/A Chen

Practitioner Massage Therapist Reston, VA

Practice location

Address: 11703 Bowman Green Dr Suite 100, Reston, VA 20190
Phone: (571) 325-9393
Mailing address: 11663 Charter Oak CT APT 202, Reston, VA 20190-4534

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 0019018570 (VA)

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Registry record

NPI: 1417722091
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Nov 2023
Record last updated: 12 Jan 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.