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General NPI Number Information
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NPI Number | 1003185323
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Entity Type | Organization
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Legal Business Name | STRESS REDUCTION SPECIALITIES, LLC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 527 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-5520
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Country | US
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Telephone | 736-458-3855
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Fax |
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Provider Business Mailing Address
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Address Line | 11800 ELDORADO ST NW 108
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City | COON RAPIDS
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State | MN
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Zip | 55433-2401
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Country | US
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Telephone | 763-458-3855
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | REBECCA JOCHUM
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Credential | CMT
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Telephone | 763-458-3855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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