Provider Demographics
NPI:1801391941
Name:CENTER FOR INTEGRATIVE MASSAGE, LLC
Entity type:Organization
Organization Name:CENTER FOR INTEGRATIVE MASSAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PENNER-HURST
Authorized Official - Suffix:
Authorized Official - Credentials:BCTMB
Authorized Official - Phone:651-343-4444
Mailing Address - Street 1:1053 GRAND AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3074
Mailing Address - Country:US
Mailing Address - Phone:651-343-4444
Mailing Address - Fax:651-343-4444
Practice Address - Street 1:1053 GRAND AVE STE 113
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3074
Practice Address - Country:US
Practice Address - Phone:651-343-4444
Practice Address - Fax:651-343-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty