Provider Demographics
NPI:1336478627
Name:SCARBOROUGH, ANN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 HANREHAN TRL
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-9786
Mailing Address - Country:US
Mailing Address - Phone:952-994-1790
Mailing Address - Fax:952-746-2819
Practice Address - Street 1:1103 W BURNSVILLE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5800
Practice Address - Country:US
Practice Address - Phone:952-994-1790
Practice Address - Fax:952-746-2819
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1770812067OtherNPI
MN1336478627OtherNPI