Provider Demographics
NPI:1811372675
Name:ALTAVISTA MEDICAL & ONCOLOGY MASSAGE THERAPY
Entity Type:Organization
Organization Name:ALTAVISTA MEDICAL & ONCOLOGY MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SILVY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:434-309-1775
Mailing Address - Street 1:600 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-1852
Mailing Address - Country:US
Mailing Address - Phone:434-309-1775
Mailing Address - Fax:
Practice Address - Street 1:600 BROAD ST
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-1852
Practice Address - Country:US
Practice Address - Phone:434-309-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012447175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty