Healthcare Provider Details

I. General information

NPI: 1619261401
Provider Name (Legal Business Name): ELENA TERESE DZURO CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 MINNETONKA MILLS RD SUITE C
MINNETONKA MN
55305-5100
US

IV. Provider business mailing address

11300 MINNETONKA MILLS RD SUITE C
MINNETONKA MN
55305-5100
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-3000
  • Fax: 952-930-3210
Mailing address:
  • Phone: 952-933-3000
  • Fax: 952-930-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: