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General NPI Number Information
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NPI Number | 1942766068
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Entity Type | Individual
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Provider Name | KATRINA JEAN CORDES LMT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 2550 UNIVERSITY AVE W # 244SOUTH
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City | SAINT PAUL
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State | MN
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Zip | 55114-1052
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Country | US
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Telephone | 612-208-2673
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Fax |
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Provider Business Mailing Address
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Address Line | 405 LAKE BLVD NW
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City | BUFFALO
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State | MN
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Zip | 55313-1041
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Country | US
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Telephone | 612-730-6710
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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 | 20160000935
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License Number State | MN
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