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General NPI Number Information
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NPI Number | 1285390765
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Entity Type | Individual
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Provider Name | GINA MARIE GAFFORD MA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 23505 SMITHTOWN RD STE 100
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City | EXCELSIOR
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State | MN
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Zip | 55331-4542
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Country | US
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Telephone | 952-470-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 324 W 4TH ST
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City | WACONIA
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State | MN
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Zip | 55387-1708
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Country | US
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Telephone | 612-910-9050
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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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