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General NPI Number Information
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NPI Number | 1669715520
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Entity Type | Organization
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Legal Business Name | SUNSET PIER CLINICAL & THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 1404 33RD ST S # G
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City | FARGO
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State | ND
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Zip | 58103-3482
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Country | US
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Telephone | 701-200-2712
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 33RD ST S # G
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City | FARGO
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State | ND
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Zip | 58103-3482
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. LELAND GREER WHITEHURST II
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Credential | LMT, NCTMB
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Telephone | 701-200-2712
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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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