Provider Demographics
NPI:1497399638
Name:VIRGINIA MEDICAL MASSAGE
Entity Type:Organization
Organization Name:VIRGINIA MEDICAL MASSAGE
Other - Org Name:VIRGINIA MEDICAL MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:FIORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:757-410-5322
Mailing Address - Street 1:680 KINGSBOROUGH SQ STE C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4988
Mailing Address - Country:US
Mailing Address - Phone:757-410-5322
Mailing Address - Fax:757-548-0670
Practice Address - Street 1:1421 KEMPSVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1406
Practice Address - Country:US
Practice Address - Phone:757-410-5322
Practice Address - Fax:757-548-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty