Provider Demographics
NPI: | 1003185323 |
---|---|
Name: | STRESS REDUCTION SPECIALITIES, LLC |
Entity Type: | Organization |
Organization Name: | STRESS REDUCTION SPECIALITIES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | REBECCA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOCHUM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CMT |
Authorized Official - Phone: | 763-458-3855 |
Mailing Address - Street 1: | 11800 ELDORADO ST NW |
Mailing Address - Street 2: | 108 |
Mailing Address - City: | COON RAPIDS |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55433-2401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 763-458-3855 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 527 COON RAPIDS BLVD NW |
Practice Address - Street 2: | |
Practice Address - City: | COON RAPIDS |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55433-5520 |
Practice Address - Country: | US |
Practice Address - Phone: | 736-458-3855 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-14 |
Last Update Date: | 2011-12-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Single Specialty |