Provider Demographics
NPI:1720378706
Name:OCEAN WAVES MASSAGE & 02 LOUNGE
Entity Type:Organization
Organization Name:OCEAN WAVES MASSAGE & 02 LOUNGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENDELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-922-3600
Mailing Address - Street 1:1675 SOUTHDALE CTR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-7015
Mailing Address - Country:US
Mailing Address - Phone:952-922-3600
Mailing Address - Fax:952-922-3600
Practice Address - Street 1:1675 SOUTHDALE CTR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-7015
Practice Address - Country:US
Practice Address - Phone:952-922-3600
Practice Address - Fax:952-922-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty