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General NPI Number Information
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NPI Number | 1932330602
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Entity Type | Individual
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Provider Name | LARAMEE JESSEN PARADISE CMT
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Gender | Female
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 1750 TOWER BLVD SUITE 102
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City | VICTORIA
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State | MN
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Zip | 55386-4566
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Country | US
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Telephone | 952-443-1652
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 944
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City | WATERTOWN
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State | MN
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Zip | 55388-0944
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Country | US
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Telephone | 612-232-4669
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Fax | 952-955-3833
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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 |
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License Number State | MN
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