Provider Demographics
NPI:1366874851
Name:II, MARCHELLE LEIALOHA (CERTIFIED MT)
Entity type:Individual
Prefix:
First Name:MARCHELLE
Middle Name:LEIALOHA
Last Name:II
Suffix:
Gender:F
Credentials:CERTIFIED MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3007
Mailing Address - Country:US
Mailing Address - Phone:804-617-3387
Mailing Address - Fax:
Practice Address - Street 1:4920 MILLRIDGE PKWY E
Practice Address - Street 2:SUITE 206
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4857
Practice Address - Country:US
Practice Address - Phone:804-617-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist