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General NPI Number Information
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NPI Number | 1346058971
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Entity Type | Individual
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Provider Name | ALISA YANG
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 790 S PLAZA DR STE 100
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1802
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Country | US
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Telephone | 763-339-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 3440 BELT LINE BLVD APT 208
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-2607
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Country | US
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Telephone | 763-339-8007
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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 | 2024-227
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License Number State | MN
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