MEDICARE: KNEADED HEALTH MASSAGE & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2824-046	WI

General Provider Information

NPI Number	:	1003052226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNEADED HEALTH MASSAGE & WELLNESS

Provider Business Mailing Address
First Line	:	769 23RD ST N
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-3852
Country	:	US
Telephone Number	:	608-790-1880
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 SAND LAKE RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-2400
Country	:	US
Telephone Number	:	608-790-1880
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. KRIS A BROWNELL
Credential	:	CMT
Telephone Number	:	608-790-1880

Provider Enumeration Date	:	12/17/2008
Last Update Date	:	11/09/2010

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Directions to “KNEADED HEALTH MASSAGE & WELLNESS ” Practice Location

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