Provider Demographics
NPI:1629230388
Name:CROWLEY, MELISSA L (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:L
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:6200 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2730
Mailing Address - Country:US
Mailing Address - Phone:763-218-1182
Mailing Address - Fax:952-548-9350
Practice Address - Street 1:6200 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2730
Practice Address - Country:US
Practice Address - Phone:763-218-1182
Practice Address - Fax:952-548-9350
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00013802171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor