Basic Information
| Provider Information | |||||||||
| NPI: | 1518348358 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VILLAGE ACUPUNCTURE AND MASSAGE THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 CLEVELAND AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551161345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517568525 | ||||||||
| FaxNumber: | 6126991207 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 CLEVELAND AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551161345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517568525 | ||||||||
| FaxNumber: | 6126991207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | GRAU | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 65169986140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 1425 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.