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General NPI Number Information
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NPI Number | 1932267861
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Entity Type | Individual
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Provider Name | TREECE MARY KAMPMEYER MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 311 RAMSEY ST
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City | SAINT PAUL
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State | MN
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Zip | 55102-2323
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Country | US
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Telephone | 651-222-5552
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Fax |
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Provider Business Mailing Address
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Address Line | 1851 COVINGTON LN
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City | EAGAN
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State | MN
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Zip | 55122-2682
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Country | US
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Telephone | 651-905-9053
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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 | 83851
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License Number State | MN
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