Provider Demographics
NPI:1104480649
Name:MAISANO, MARIA (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MAISANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 BYWATER DR APT 231
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6603
Mailing Address - Country:US
Mailing Address - Phone:631-495-8083
Mailing Address - Fax:
Practice Address - Street 1:3536 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2200
Practice Address - Country:US
Practice Address - Phone:804-673-9355
Practice Address - Fax:804-359-8344
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016894225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist