Healthcare Provider Details

I. General information

NPI: 1942918735
Provider Name (Legal Business Name): LINDSEY DORNBURG MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY DORNBURN

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REGIONAL HEALTH CENTER, INC. 307 IVY AVE SE
RICHMOND MN
56368-4509
US

IV. Provider business mailing address

307 IVY AVE SE
RICHMOND MN
56368-4509
US

V. Phone/Fax

Practice location:
  • Phone: 320-321-0166
  • Fax: 320-321-0167
Mailing address:
  • Phone: 320-321-0166
  • Fax: 320-321-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3737
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: