Provider Demographics
NPI:1356842116
Name:CONDE, SANDRA VIVIANA (CMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:VIVIANA
Last Name:CONDE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 8TH AVE S APT 201
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7633
Mailing Address - Country:US
Mailing Address - Phone:763-334-3763
Mailing Address - Fax:
Practice Address - Street 1:15 8TH AVE N STE 1
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7611
Practice Address - Country:US
Practice Address - Phone:952-933-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty