Provider Demographics
NPI:1760139869
Name:PEDERSEN, ELISABETH (NCBTMB, CMT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:NCBTMB, CMT
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT, NCBTMB
Mailing Address - Street 1:1224 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1224 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1130
Practice Address - Country:US
Practice Address - Phone:612-399-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist