Provider Demographics
NPI:1396219697
Name:SPECTRUM MASSAGE AND YOGA THERAPY
Entity Type:Organization
Organization Name:SPECTRUM MASSAGE AND YOGA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWIEFELHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:612-209-2607
Mailing Address - Street 1:1821 BUHNE DR SPC 38
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6874
Mailing Address - Country:US
Mailing Address - Phone:612-209-2607
Mailing Address - Fax:
Practice Address - Street 1:1821 BUHNE DR SPC 38
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-6874
Practice Address - Country:US
Practice Address - Phone:612-209-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty