Provider Demographics
NPI:1801188099
Name:KITZKE, VIRGINIA A (LMT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:A
Last Name:KITZKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LANCASTER DR
Mailing Address - Street 2:SUITE # 3A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2979
Mailing Address - Country:US
Mailing Address - Phone:775-971-9783
Mailing Address - Fax:
Practice Address - Street 1:155 LANCASTER DR
Practice Address - Street 2:SUITE # 3A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-1992
Practice Address - Country:US
Practice Address - Phone:775-971-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV.NVMT # 4230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4230OtherNEVADA STATE BOARD OF MASSAGE THERAPISTS
NV575014-09OtherNATIONAL CERTIFICATION BOARD FOR THERAPUETIC MASSAGE