Provider Demographics
NPI:1710391768
Name:THUNDER, ROSE (CMT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:THUNDER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 LANDER AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9398
Mailing Address - Country:US
Mailing Address - Phone:612-867-1335
Mailing Address - Fax:
Practice Address - Street 1:112 CENTRAL AVE E STE B
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9511
Practice Address - Country:US
Practice Address - Phone:612-867-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist