Provider Demographics
NPI:1225688203
Name:SYNSTELIEN, WANDA (LMT, RYT)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:
Last Name:SYNSTELIEN
Suffix:
Gender:F
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 LAKOTA LN STE A
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4401
Mailing Address - Country:US
Mailing Address - Phone:507-828-0668
Mailing Address - Fax:
Practice Address - Street 1:445 LAKOTA LN STE A
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-4401
Practice Address - Country:US
Practice Address - Phone:507-828-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist