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General NPI Number Information
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NPI Number | 1700184439
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Entity Type | Organization
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Legal Business Name | BRIGHTSTAR HEALING THERAPY
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 427 VERMILLION ST
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City | HASTINGS
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State | MN
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Zip | 55033-1937
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Country | US
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Telephone | 612-961-7651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28262
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City | OAKDALE
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State | MN
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Zip | 55128-0262
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Country | US
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Telephone | 612-961-7651
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIGHTSTAR BJ HARMON-INYANG
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Credential |
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Telephone | 612-961-7651
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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 | 12-06-10
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License Number State | MN
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