Provider Demographics
NPI:1043614381
Name:CONNAUGHTON, MARIE-NOELLE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE-NOELLE
Middle Name:
Last Name:CONNAUGHTON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 STONEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1016
Mailing Address - Country:US
Mailing Address - Phone:571-269-4732
Mailing Address - Fax:
Practice Address - Street 1:4023 CHAIN BRIDGE RD
Practice Address - Street 2:ARCADIA MASSAGE
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4108
Practice Address - Country:US
Practice Address - Phone:571-269-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019009932OtherCERTIFIED MASSAGE THERAPIST