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General NPI Number Information
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NPI Number | 1407594096
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Entity Type | Individual
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Provider Name | ELSA TANA DEEN
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Gender | Female
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 11861 WESTLINE INDUSTRIAL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3305
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Country | US
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Telephone | 314-392-9762
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Fax |
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Provider Business Mailing Address
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Address Line | 2332 BATTLEFIELD DR
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City | FLORISSANT
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State | MO
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Zip | 63031-2728
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Country | US
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Telephone | 314-616-5285
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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 | 2015042182
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License Number State | MO
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