Healthcare Provider Details

I. General information

NPI: 1497498067
Provider Name (Legal Business Name): MORGAN HASTINGS MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 32ND AVE N
SAINT CLOUD MN
56303-1649
US

IV. Provider business mailing address

1246 32ND AVE N
SAINT CLOUD MN
56303-1649
US

V. Phone/Fax

Practice location:
  • Phone: 320-230-8920
  • Fax:
Mailing address:
  • Phone: 320-230-8920
  • Fax: 320-230-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: