Provider Demographics
NPI:1710251079
Name:MASSAGE ELEMENTS, LLC
Entity Type:Organization
Organization Name:MASSAGE ELEMENTS, LLC
Other - Org Name:MASSAGE ELEMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-686-0587
Mailing Address - Street 1:770 HIGHWAY 110
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1509
Mailing Address - Country:US
Mailing Address - Phone:651-686-0587
Mailing Address - Fax:
Practice Address - Street 1:770 HIGHWAY 110
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1509
Practice Address - Country:US
Practice Address - Phone:651-686-0587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty