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General NPI Number Information
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NPI Number | 1073465753
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Entity Type | Organization
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Legal Business Name | DWAY EASTERN THERAPEUTIC BODYWORK LLC
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 7600 BASS LAKE RD
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City | NEW HOPE
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State | MN
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Zip | 55428-3860
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Country | US
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Telephone | 612-249-3132
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Fax | 612-249-3132
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Provider Business Mailing Address
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Address Line | 7600 BASS LAKE RD
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City | NEW HOPE
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State | MN
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Zip | 55428-3860
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Country | US
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Telephone | 612-249-3132
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Fax | 612-249-3132
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Authorized Official
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Title or Position | CEO
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Name | DENISE ANTIONETTE FRAZIER
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Credential |
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Telephone | 612-249-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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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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