Healthcare Provider Details

I. General information

NPI: 1093530719
Provider Name (Legal Business Name): TONYA KAY FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 REIMER DR N STE 250
MAPLE GROVE MN
55311-4581
US

IV. Provider business mailing address

13700 REIMER DR N STE 250
MAPLE GROVE MN
55311-4581
US

V. Phone/Fax

Practice location:
  • Phone: 763-420-2226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2024-59
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: