Provider Demographics
NPI:1407189947
Name:ADVANCED THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:ADVANCED THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LENSELINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-835-6653
Mailing Address - Street 1:5001 AMERICAN BLVD W STE 945
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1162
Mailing Address - Country:US
Mailing Address - Phone:952-835-6653
Mailing Address - Fax:952-835-3895
Practice Address - Street 1:5001 AMERICAN BLVD W STE 945
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1162
Practice Address - Country:US
Practice Address - Phone:952-835-6653
Practice Address - Fax:952-835-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty