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General NPI Number Information
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NPI Number | 1861217093
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Entity Type | Organization
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Legal Business Name | FAITHFULLY MASSAGE & BODYWORK, LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 2353 RICE ST STE 130
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City | ROSEVILLE
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State | MN
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Zip | 55113-3770
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Country | US
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Telephone | 651-443-1980
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 MARLIN AVE
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-5086
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Country | US
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Telephone | 651-443-1980
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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 | FAITH YING XIONGBLAXANG
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Credential | MT
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Telephone | 651-443-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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