Healthcare Provider Details

I. General information

NPI: 1982921938
Provider Name (Legal Business Name): AMIEE ELIZABETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W LAKE ST
MINNEAPOLIS MN
55408-3119
US

IV. Provider business mailing address

4051 26TH AVE S
MINNEAPOLIS MN
55406-3037
US

V. Phone/Fax

Practice location:
  • Phone: 612-823-2020
  • Fax:
Mailing address:
  • Phone: 612-860-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: