Provider Demographics
NPI:1699380097
Name:STAFFORD MASSAGE CENTER LLC
Entity Type:Organization
Organization Name:STAFFORD MASSAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-237-7514
Mailing Address - Street 1:385 GARRISONVILLE RD STE 211
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1545
Mailing Address - Country:US
Mailing Address - Phone:540-288-8888
Mailing Address - Fax:
Practice Address - Street 1:385 GARRISONVILLE RD STE 211
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1545
Practice Address - Country:US
Practice Address - Phone:540-288-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty