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General NPI Number Information
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NPI Number | 1174466353
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Entity Type | Individual
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Provider Name | MALAKAI SWANSON
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Gender | Male
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 16372 KENRICK AVE
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City | LAKEVILLE
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State | MN
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Zip | 55044-3540
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Country | US
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Telephone | 612-254-9008
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 KIRKWOOD DR
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City | EAGAN
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State | MN
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Zip | 55123-1930
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Country | US
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Telephone | 612-306-9997
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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 | MN
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