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General NPI Number Information
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NPI Number | 1316808496
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Entity Type | Organization
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Legal Business Name | DESIR HOLISTIC THERAPY LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 576 FRONT AVE
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City | SAINT PAUL
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State | MN
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Zip | 55117-4709
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Country | US
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Telephone | 612-405-5876
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6836
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City | SAINT PAUL
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State | MN
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Zip | 55106-0836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WIDLYNE WALKER
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Credential |
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Telephone | 612-405-5876
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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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