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General NPI Number Information
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NPI Number | 1336801836
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Entity Type | Organization
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Legal Business Name | SOUL LOGIC, LLC
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 856 RAYMOND AVE STE B
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City | SAINT PAUL
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State | MN
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Zip | 55114-1598
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Country | US
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Telephone | 651-788-7903
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Fax |
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Provider Business Mailing Address
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Address Line | 856 RAYMOND AVE STE B
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City | SAINT PAUL
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State | MN
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Zip | 55114-1598
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Country | US
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Telephone | 651-788-7903
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | DR. MONA ROBBINS
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Credential | DOAM
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Telephone | 612-845-5588
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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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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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