Provider Demographics
NPI:1275384869
Name:RADIANT HEALTH MASSAGE LLC.
Entity Type:Organization
Organization Name:RADIANT HEALTH MASSAGE LLC.
Other - Org Name:RADIANT HEALTH MASSAGE LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CLT
Authorized Official - Phone:571-368-4084
Mailing Address - Street 1:3985 PRINCE WILLIAM PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7900
Mailing Address - Country:US
Mailing Address - Phone:571-368-4084
Mailing Address - Fax:
Practice Address - Street 1:3985 PRINCE WILLIAM PKWY STE 206
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7900
Practice Address - Country:US
Practice Address - Phone:571-359-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty