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NPI Code Detail

MEDICARE: BIRHANU AFSAW DESTA

MEDICARE: BIRHANU AFSAW DESTA
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1982218806
Entity Type Code : Individual
Provider Name (Legal Business Name) : BIRHANU AFSAW DESTA
Provider Business Mailing Address
First Line : 2627 E FRANKLIN AVE STE 201
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1168
Country : US
Telephone Number : 161-287-0150
Fax Number :
Provider Business Practice Location Address
First Line : 2627 E FRANKLIN AVE STE 201
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1168
Country : US
Telephone Number : 161-287-0150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2020
Last Update Date : 09/08/2020

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Directions to “ BIRHANU AFSAW DESTA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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