Provider Demographics
NPI:1508527359
Name:TINDELL, ROBERT JOHN (LCMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:TINDELL
Suffix:
Gender:M
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8366 680TH ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-4513
Mailing Address - Country:US
Mailing Address - Phone:715-505-4663
Mailing Address - Fax:
Practice Address - Street 1:7373 147TH ST W STE 108
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7532
Practice Address - Country:US
Practice Address - Phone:651-460-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist