NPIMap

Organization Active NPI

New River Mediccal Massage

  • Specialist
  • Radford, VA
National Provider Identifier
1194105247
Registry record updated Jun 4, 2015
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Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
0019001695 Issued in VA
Legal business name
NEW RIVER MEDICCAL MASSAGE
Practice address
319 W Main St
Radford, VA 24141-1586
Phone
(540) 633-3828
Fax
(540) 633-3829
NPI assigned
Jun 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert Ernest Wallace, MASSAGE THERAPIST
Title
Owner/Therapist
Phone
(540) 633-3828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 0019001695 VA Primary

Addresses

Primary practice location

319 W Main St
Radford, VA 24141-1586

Mailing address

319 West Main Street
Radford, VA 24301
Phone (540) 633-3828

Other identifiers 1

IdentifierTypeStateIssuer
225700000XOtherVAMASSAGE THERAPY

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433376000000",
    "number": "1194105247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 WEST MAIN STREET",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "24301",
            "telephone_number": "540-633-3828",
            "fax_number": "540-633-3829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W MAIN ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411586",
            "telephone_number": "540-633-3828",
            "fax_number": "540-633-3829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER MEDICCAL MASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-06-04",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ERNEST",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "540-633-3828",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MASSAGE THERAPIST"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0019001695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSAGE THERAPY",
            "identifier": "225700000X",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Radford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.