Healthcare Provider Details

I. General information

NPI: 1205134616
Provider Name (Legal Business Name): BODY KNEADS MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BUSH ST
RED WING MN
55066-2526
US

IV. Provider business mailing address

316 BUSH ST
RED WING MN
55066-2526
US

V. Phone/Fax

Practice location:
  • Phone: 651-267-0118
  • Fax:
Mailing address:
  • Phone: 651-267-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAWN ELIZABETH BENNETT NORDIN
Title or Position: OWNER
Credential: NCTMB, LMT, CHC
Phone: 651-267-0118