Provider Demographics
NPI:1528387495
Name:POWER MASSAGE LLC
Entity Type:Organization
Organization Name:POWER MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEEDLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:763-780-9662
Mailing Address - Street 1:620 CIVIC HEIGHTS DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-4711
Mailing Address - Country:US
Mailing Address - Phone:763-780-9662
Mailing Address - Fax:763-780-9662
Practice Address - Street 1:620 CIVIC HEIGHTS DR
Practice Address - Street 2:SUITE 109
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-4711
Practice Address - Country:US
Practice Address - Phone:763-780-9662
Practice Address - Fax:763-780-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty