Healthcare Provider Details

I. General information

NPI: 1336801836
Provider Name (Legal Business Name): SOUL LOGIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 RAYMOND AVE STE B
SAINT PAUL MN
55114-1598
US

IV. Provider business mailing address

856 RAYMOND AVE STE B
SAINT PAUL MN
55114-1598
US

V. Phone/Fax

Practice location:
  • Phone: 651-788-7903
  • Fax:
Mailing address:
  • Phone: 651-788-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MONA ROBBINS
Title or Position: OWNER, MANAGER
Credential: DOAM
Phone: 612-845-5588