Provider Demographics
NPI:1215523519
Name:ELEMENTS OF HEALTH VA LLC
Entity type:Organization
Organization Name:ELEMENTS OF HEALTH VA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTE
Authorized Official - Middle Name:LATRYCE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CHES
Authorized Official - Phone:757-529-1647
Mailing Address - Street 1:4247 WHITE CAP CRST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3256
Mailing Address - Country:US
Mailing Address - Phone:678-702-7290
Mailing Address - Fax:757-695-9801
Practice Address - Street 1:4300 PORTSMOUTH BLVD STE 262
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2138
Practice Address - Country:US
Practice Address - Phone:757-956-5742
Practice Address - Fax:757-695-9801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNTE L PETERSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-21
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty