Healthcare Provider Details

I. General information

NPI: 1265336861
Provider Name (Legal Business Name): TRAN LEGACY WELLNESS & RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7056 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

IV. Provider business mailing address

7056 E FISH LAKE RD
MAPLE GROVE MN
55311-2832
US

V. Phone/Fax

Practice location:
  • Phone: 651-788-1238
  • Fax:
Mailing address:
  • Phone: 651-788-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THAO TRAN
Title or Position: OWNER
Credential: DCM, LAC, MT
Phone: 651-788-1238