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General NPI Number Information
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NPI Number | 1154658516
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Entity Type | Individual
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Provider Name | NINA MARIE CORTEZ C.B.T.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 221 1ST AVE NE
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City | OSSEO
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State | MN
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Zip | 55369-1201
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Country | US
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Telephone | 612-644-6353
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Fax |
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Provider Business Mailing Address
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Address Line | 7425 RIVER SHORE LN
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City | CHAMPLIN
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State | MN
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Zip | 55316-2140
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Country | US
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Telephone | 612-644-6353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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