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General NPI Number Information
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NPI Number | 1700396249
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Entity Type | Individual
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Provider Name | ANTHONY JAMES DOVOLOS
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Gender | Male
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 2937 LYNDALE AVE S STE B002C
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2171
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Country | US
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Telephone | 612-879-8000
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Fax | 612-879-8000
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Provider Business Mailing Address
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Address Line | 1357 IDAHO AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-2207
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Country | US
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Telephone | 952-288-6958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9522886958
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License Number State | MN
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