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General NPI Number Information
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NPI Number | 1467934778
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Entity Type | Organization
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Legal Business Name | NMT SPECIALTIES
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 4804 S MINNESOTA AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5023
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Country | US
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Telephone | 605-759-5198
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Fax |
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Provider Business Mailing Address
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Address Line | 417 N CRESTVIEW DR
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City | BRANDON
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State | SD
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Zip | 57005-2536
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Country | US
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Telephone | 605-759-5198
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GINA BUCHANAN
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Credential | NMT
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Telephone | 605-759-5198
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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 | MT1142
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License Number State |
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