Provider Demographics
NPI:1285209494
Name:TRANQUIL ASSUAGE
Entity Type:Organization
Organization Name:TRANQUIL ASSUAGE
Other - Org Name:TRANQUIL ASSUAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANDRIDGE-WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:NBCMT, LMT, MMP
Authorized Official - Phone:434-328-6163
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0695
Mailing Address - Country:US
Mailing Address - Phone:434-328-6163
Mailing Address - Fax:434-296-5433
Practice Address - Street 1:505 FAULCONER DR STE 2B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4981
Practice Address - Country:US
Practice Address - Phone:434-328-6163
Practice Address - Fax:434-296-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty