Healthcare Provider Details

I. General information

NPI: 1932048519
Provider Name (Legal Business Name): PAIGE PICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23505 SMITHTOWN RD STE 100
EXCELSIOR MN
55331-4542
US

IV. Provider business mailing address

23505 SMITHTOWN RD STE 100
EXCELSIOR MN
55331-4542
US

V. Phone/Fax

Practice location:
  • Phone: 952-470-8555
  • Fax: 952-401-8785
Mailing address:
  • Phone: 952-470-8555
  • Fax: 952-401-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: