Healthcare Provider Details

I. General information

NPI: 1831825520
Provider Name (Legal Business Name): SAMANTHA GREENFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 NORTHWEST BLVD STE 230
PLYMOUTH MN
55441-2644
US

IV. Provider business mailing address

2905 NORTHWEST BLVD
PLYMOUTH MN
55441-7400
US

V. Phone/Fax

Practice location:
  • Phone: 612-367-4824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: