Provider Demographics
NPI:1326279100
Name:REESE, MARLENA PADRON (MASSOTHERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARLENA
Middle Name:PADRON
Last Name:REESE
Suffix:
Gender:F
Credentials:MASSOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 WARWICK BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3222
Mailing Address - Country:US
Mailing Address - Phone:757-635-6758
Mailing Address - Fax:
Practice Address - Street 1:11010 WARWICK BLVD STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3222
Practice Address - Country:US
Practice Address - Phone:757-635-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
VA133NN1002X133NN1002X
VA0019000957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332BP00XMedicaid