Provider Demographics
NPI:1861217093
Name:FAITHFULLY MASSAGE & BODYWORK, LLC
Entity type:Organization
Organization Name:FAITHFULLY MASSAGE & BODYWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:YING
Authorized Official - Last Name:XIONGBLAXANG
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:651-443-1980
Mailing Address - Street 1:3209 MARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-5086
Mailing Address - Country:US
Mailing Address - Phone:651-443-1980
Mailing Address - Fax:
Practice Address - Street 1:3485 WILLOW LAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-5153
Practice Address - Country:US
Practice Address - Phone:651-443-1980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation