Provider Demographics
NPI:1467756726
Name:ANSHIN MASSAGE AND BODYWORK LLC
Entity Type:Organization
Organization Name:ANSHIN MASSAGE AND BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-807-6836
Mailing Address - Street 1:1322 FOX ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8731
Mailing Address - Country:US
Mailing Address - Phone:763-807-6836
Mailing Address - Fax:
Practice Address - Street 1:620 BABCOCK BLVD E
Practice Address - Street 2:SUITE 5
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8603
Practice Address - Country:US
Practice Address - Phone:763-807-6836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
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