Provider Demographics
NPI:1295413334
Name:GLACIER CHILL ONSITE & MOBILE CRYOTHERAPY
Entity type:Organization
Organization Name:GLACIER CHILL ONSITE & MOBILE CRYOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-382-2009
Mailing Address - Street 1:13455 SUNRISE VALLEY DR UNIT 2016
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3392
Mailing Address - Country:US
Mailing Address - Phone:859-382-2009
Mailing Address - Fax:
Practice Address - Street 1:13455 SUNRISE VALLEY DR UNIT 2016
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3392
Practice Address - Country:US
Practice Address - Phone:859-382-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology