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NPI Code Detail

MEDICARE: NATHAN FLETCHER LMT

MEDICARE: NATHAN FLETCHER LMT
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1023248259
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN FLETCHER LMT
Provider Business Mailing Address
First Line : 4791 34TH AVE N
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-2851
Country : US
Telephone Number : 612-978-2916
Fax Number :
Provider Business Practice Location Address
First Line : 2200 HENNEPIN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-2737
Country : US
Telephone Number : 612-978-2916
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2009
Last Update Date : 07/22/2009

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