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General NPI Number Information
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NPI Number | 1528387495
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Entity Type | Organization
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Legal Business Name | POWER MASSAGE LLC
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 620 CIVIC HEIGHTS DR SUITE 109
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City | CIRCLE PINES
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State | MN
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Zip | 55014-4711
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Country | US
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Telephone | 763-780-9662
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Fax | 763-780-9662
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Provider Business Mailing Address
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Address Line | 620 CIVIC HEIGHTS DR SUITE 109
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City | CIRCLE PINES
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State | MN
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Zip | 55014-4711
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Country | US
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Telephone | 763-780-9662
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Fax | 763-780-9662
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT W BEEDLE JR.
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Credential |
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Telephone | 763-780-9662
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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 |
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License Number State |
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