MEDICARE: AIMEE MCKENNON

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

General Provider Information

NPI Number	:	1538011622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE MCKENNON

Provider Business Mailing Address
First Line	:	2800 E 40TH ST UNIT 4
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3082
Country	:	US
Telephone Number	:	651-666-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 E 40TH ST UNIT 4
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3082
Country	:	US
Telephone Number	:	651-666-8885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ AIMEE MCKENNON ” Practice Location

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