Provider Demographics
NPI:1992940548
Name:OVERSTREET, VIRGINIA KAY
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:KAY
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE 309 ST
Mailing Address - Street 2:
Mailing Address - City:CROSS CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32628-3608
Mailing Address - Country:US
Mailing Address - Phone:352-356-1381
Mailing Address - Fax:
Practice Address - Street 1:226 SE 309 ST
Practice Address - Street 2:
Practice Address - City:CROSS CITY
Practice Address - State:FL
Practice Address - Zip Code:32628-3608
Practice Address - Country:US
Practice Address - Phone:352-356-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#53275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist