Provider Demographics
NPI:1336696491
Name:PIER 6 THERAPY LLC
Entity Type:Organization
Organization Name:PIER 6 THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATELYNNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:540-784-3424
Mailing Address - Street 1:P.O. BOX 32
Mailing Address - Street 2:
Mailing Address - City:IRON GATE
Mailing Address - State:VA
Mailing Address - Zip Code:24448
Mailing Address - Country:US
Mailing Address - Phone:540-784-3424
Mailing Address - Fax:
Practice Address - Street 1:303 6TH STREET
Practice Address - Street 2:
Practice Address - City:IRON GATE
Practice Address - State:VA
Practice Address - Zip Code:24448
Practice Address - Country:US
Practice Address - Phone:540-784-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty