Provider Demographics
NPI:1013796325
Name:MEDICAL MASSAGE CLINIC, INC
Entity Type:Organization
Organization Name:MEDICAL MASSAGE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FEDUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:540-907-5989
Mailing Address - Street 1:10500 WAKEMAN DR STE 500
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8014
Mailing Address - Country:US
Mailing Address - Phone:540-785-7888
Mailing Address - Fax:
Practice Address - Street 1:10500 WAKEMAN DR STE 500
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8014
Practice Address - Country:US
Practice Address - Phone:540-785-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty