Provider Demographics
NPI:1316217664
Name:MABRY, VERNON (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:MABRY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 GRESHAM RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1437
Mailing Address - Country:US
Mailing Address - Phone:301-879-1819
Mailing Address - Fax:
Practice Address - Street 1:1329 GRESHAM RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1437
Practice Address - Country:US
Practice Address - Phone:301-879-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1077225700000X
MDM03790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist