Provider Demographics
NPI:1508156977
Name:CHANGEMAKER, INC.
Entity Type:Organization
Organization Name:CHANGEMAKER, INC.
Other - Org Name:MASSAGE BY LITAHNI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LITAHNI
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMT, CTC
Authorized Official - Phone:763-427-0212
Mailing Address - Street 1:12400 MARION LN W
Mailing Address - Street 2:#3204
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1376
Mailing Address - Country:US
Mailing Address - Phone:763-427-0212
Mailing Address - Fax:
Practice Address - Street 1:4165 SHORELINE DR
Practice Address - Street 2:#50
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-9659
Practice Address - Country:US
Practice Address - Phone:763-427-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty