Healthcare Provider Details

I. General information

NPI: 1073338158
Provider Name (Legal Business Name): CAITLIN THOMPSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 CLEVELAND AVE S
SAINT PAUL MN
55116-1345
US

IV. Provider business mailing address

730 CLEVELAND AVE S
SAINT PAUL MN
55116-1345
US

V. Phone/Fax

Practice location:
  • Phone: 651-756-8525
  • Fax: 651-699-1207
Mailing address:
  • Phone: 651-756-8525
  • Fax: 651-699-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20240001823
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: