=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053844977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREAT MASSAGE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2017
-----------------------------------------------------
Last Update Date | 04/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 812 E 48TH ST STE 2
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55417-1067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-250-8620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 E 48TH ST STE 2
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55417-1067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-250-8620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MARY KATHRYN TREAT
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 612-250-8620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | L322 50261
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------