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General NPI Number Information
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NPI Number | 1669127726
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Entity Type | Organization
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Legal Business Name | COMFORT CORNER MASSAGE
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 315 JEFFERSON ST S
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City | WADENA
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State | MN
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Zip | 56482-1533
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Country | US
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Telephone | 240-460-8845
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Fax |
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Provider Business Mailing Address
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Address Line | 32749 199TH AVE
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City | MENAHGA
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State | MN
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Zip | 56464-2715
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Country | US
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Telephone | 240-460-8845
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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 | MICHELLE L KROTZER
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Credential | MT, RN
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Telephone | 240-460-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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