MEDICARE: CHERRY ANNE WISEMAN MASSAGE THERAPIST

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	:	1528660818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERRY ANNE WISEMAN MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	3031 LONSDALE BLVD W
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-4720
Country	:	US
Telephone Number	:	952-393-8750
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 S PLAZA DR STE 124
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1505
Country	:	US
Telephone Number	:	651-406-4454
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “ CHERRY ANNE WISEMAN MASSAGE THERAPIST” Practice Location

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