Provider Demographics
NPI:1427748904
Name:KO, KATHY JUNG (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JUNG
Last Name:KO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9327 MIDLOTHIAN TPKE STE 1G
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4965
Mailing Address - Country:US
Mailing Address - Phone:804-464-3315
Mailing Address - Fax:866-398-5592
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 1G
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4965
Practice Address - Country:US
Practice Address - Phone:804-464-3315
Practice Address - Fax:866-398-5592
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014094225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist