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General NPI Number Information
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NPI Number | 1346528619
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Entity Type | Organization
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Legal Business Name | KAYS MASSAGE
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 1001 JOHNSON PKWY STE 171
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City | SAINT PAUL
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State | MN
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Zip | 55106-3474
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Country | US
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Telephone | 651-434-9397
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 JOHNSON PKWY STE 171
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City | SAINT PAUL
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State | MN
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Zip | 55106-3474
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Country | US
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Telephone | 651-434-9397
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MS. KONG XIONG
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Credential | CT
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Telephone | 651-434-9397
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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 | 20110001127
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License Number State | MN
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