Provider Demographics
NPI:1568756740
Name:LUCHTENBURG, JONI L (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:L
Last Name:LUCHTENBURG
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MILL ST E
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56128-4412
Mailing Address - Country:US
Mailing Address - Phone:507-442-4848
Mailing Address - Fax:
Practice Address - Street 1:321 MILL ST E
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:MN
Practice Address - Zip Code:56128-4412
Practice Address - Country:US
Practice Address - Phone:507-442-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
SD173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist