MEDICARE: POWER MASSAGE LLC

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

General Provider Information

NPI Number	:	1528387495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWER MASSAGE LLC

Provider Business Mailing Address
First Line	:	620 CIVIC HEIGHTS DR
Second Line	:	SUITE 109
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-4711
Country	:	US
Telephone Number	:	763-780-9662
Fax Number	:	763-780-9662

Provider Business Practice Location Address
First Line	:	620 CIVIC HEIGHTS DR
Second Line	:	SUITE 109
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-4711
Country	:	US
Telephone Number	:	763-780-9662
Fax Number	:	763-780-9662

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT W BEEDLE JR.
Credential	:
Telephone Number	:	763-780-9662

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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Directions to “POWER MASSAGE LLC ” Practice Location

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