NEW RIVER MEDICCAL MASSAGE NPI 1194105247

NPI Information

  • NPI: 1194105247
  • Provider Name: NEW RIVER MEDICCAL MASSAGE
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 49D0891401
  • Address: 319 W MAIN ST
    RADFORD, VA
    ZIP 24141
  • Phone: (540) 633-3828

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NPI Details

NEW RIVER MEDICCAL MASSAGE is a specialist in Radford, VA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. NEW RIVER MEDICCAL MASSAGE NPI is 1194105247. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

319 W MAIN ST
RADFORD, VA
ZIP 24141-586
Phone: (540) 633-3828
Fax: (540) 633-3829

The provider's authorized official is Robert Ernest Wallace .
The authorized official title is Owner/therapist and has the following contact phone number (540) 633-3828.

The CLIA number assigned to this NPI record is 49D0891401 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2015 and was last updated on 6/4/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist0019001695VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1225700000XOTHERVIRGINIAMASSAGE THERAPY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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