MEDICARE: MR. JOEL M RONNINGEN 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
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1932477676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL M RONNINGEN LMT

Provider Business Mailing Address
First Line	:	14036 HEYWOOD PATH
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13335 PALOMINO DR
Second Line	:	SUITE 206
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-4248
Country	:	US
Telephone Number	:	651-295-1127
Fax Number	:

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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