Healthcare Provider Details

I. General information

NPI: 1710251079
Provider Name (Legal Business Name): MASSAGE ELEMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 HIGHWAY 110
MENDOTA HEIGHTS MN
55120-1509
US

IV. Provider business mailing address

770 HIGHWAY 110
MENDOTA HEIGHTS MN
55120-1509
US

V. Phone/Fax

Practice location:
  • Phone: 651-686-0587
  • Fax:
Mailing address:
  • Phone: 651-686-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANN F SHORT
Title or Position: OWNER
Credential:
Phone: 651-686-0587