Provider Demographics
NPI:1558539460
Name:EMORY, BARBARA DIANE (LMT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:DIANE
Last Name:EMORY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 BOLLINGBROOK ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4548
Mailing Address - Country:US
Mailing Address - Phone:804-722-1720
Mailing Address - Fax:804-722-1721
Practice Address - Street 1:1302 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2739
Practice Address - Country:US
Practice Address - Phone:804-524-0252
Practice Address - Fax:804-722-1721
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA14565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist