Healthcare Provider Details

I. General information

NPI: 1518795392
Provider Name (Legal Business Name): PRACTICAL & CREATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 PENN AVE S STE 248
BLOOMINGTON MN
55431-1358
US

IV. Provider business mailing address

8120 PENN AVE S STE 248
BLOOMINGTON MN
55431-1358
US

V. Phone/Fax

Practice location:
  • Phone: 952-303-5780
  • Fax: 952-303-6888
Mailing address:
  • Phone: 952-303-5780
  • Fax: 952-303-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. IVONNE MARCELA MOSQUERA-SCHMIDT
Title or Position: OWNER, DCM, MASSAGE TP
Credential: DCM
Phone: 952-303-5780