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General NPI Number Information
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NPI Number | 1841015120
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Entity Type | Organization
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Legal Business Name | EV MASSAGE & WELLNESS LLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 911 MARYLAND AVE E STE G6
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City | SAINT PAUL
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State | MN
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Zip | 55106-2647
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Country | US
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Telephone | 763-258-9047
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Fax |
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Provider Business Mailing Address
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Address Line | 6916 IDAHO AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55428-1780
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Country | US
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Telephone | 763-258-9047
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST/ SOLE PROPRIETOR
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Name | ELIZABETH VANG
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Credential |
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Telephone | 763-258-9047
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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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