Provider Demographics
NPI:1235526070
Name:REHABILITATIVE CONNECTIONS
Entity Type:Organization
Organization Name:REHABILITATIVE CONNECTIONS
Other - Org Name:LIVE, LOVE, MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:540-400-0004
Mailing Address - Street 1:2105 ELECTRIC RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2315
Mailing Address - Country:US
Mailing Address - Phone:540-400-0004
Mailing Address - Fax:
Practice Address - Street 1:2105 ELECTRIC RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2315
Practice Address - Country:US
Practice Address - Phone:540-400-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty