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General NPI Number Information
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NPI Number | 1003260977
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Entity Type | Organization
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Legal Business Name | PEACEWORKS
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 4820 MINNETONKA BLVD
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-2263
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Country | US
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Telephone | 612-965-0542
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Fax |
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Provider Business Mailing Address
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Address Line | 95 COACH LIGHT DR
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City | HUDSON
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State | WI
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Zip | 54016-7770
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Country | US
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Telephone | 612-965-0563
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MS. JULIANNE DRUZBACKY
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Credential | LMT
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Telephone | 612-965-0542
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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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