MEDICARE: GRETCHEN LYNN PEARSON CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	79867	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	79867	OTHER	CA	CERTIFIED MASSAGE THERAPIST

General Provider Information

NPI Number	:	1013638659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LYNN PEARSON CMT

Provider Business Mailing Address
First Line	:	1717 2ND ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1139
Country	:	US
Telephone Number	:	612-399-6322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 2ND ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1139
Country	:	US
Telephone Number	:	612-399-6322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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