Healthcare Provider Details

I. General information

NPI: 1770812067
Provider Name (Legal Business Name): DYNAMIC JOURNEY MASSAGE & WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W BURNSVILLE PKWY STE 200
BURNSVILLE MN
55337-5800
US

IV. Provider business mailing address

4219 HANREHAN TRL SCARBOROUGH
SAVAGE MN
55378-9786
US

V. Phone/Fax

Practice location:
  • Phone: 952-994-1790
  • Fax: 952-746-2819
Mailing address:
  • Phone: 952-994-1790
  • Fax: 952-746-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN SCARBOROUGH
Title or Position: OWNER/MASSAGE THERAPIST
Credential: MT
Phone: 952-994-1790