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General NPI Number Information
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NPI Number | 1497262299
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Entity Type | Organization
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Legal Business Name | MARSALU, INC.
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 5640 W 36TH ST
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2509
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Country | US
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Telephone | 952-222-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 5640 W 36TH ST
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2509
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Country | US
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Telephone | 952-222-3000
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SAMUEL FOSTER
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Credential |
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Telephone | 612-718-6107
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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 | 42818
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License Number State | MN
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