MEDICARE: DANICA KRIZIC MASSAGE THERAPIST

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		MN
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1740710599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANICA KRIZIC MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	5009 EXCELSIOR BLVD STE 141
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3035
Country	:	US
Telephone Number	:	952-255-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	5009 EXCELSIOR BLVD STE 141
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3035
Country	:	US
Telephone Number	:	952-255-9399
Fax Number	:

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

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	03/28/2018

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