Provider Demographics
NPI:1700645611
Name:ORISA MASSAGE
Entity Type:Organization
Organization Name:ORISA MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADEYINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWETAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:571-659-5239
Mailing Address - Street 1:7204 WILLOW HILL DR
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2671
Mailing Address - Country:US
Mailing Address - Phone:240-455-8233
Mailing Address - Fax:
Practice Address - Street 1:1401 MERCANTILE LN STE 200F
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4310
Practice Address - Country:US
Practice Address - Phone:571-659-5239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty