Provider Demographics
NPI:1891142881
Name:TALBOT, JOANNE MARIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:MARIE
Last Name:TALBOT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 MANOR DR NE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1272
Mailing Address - Country:US
Mailing Address - Phone:763-784-0902
Mailing Address - Fax:
Practice Address - Street 1:305 FREMONT ST
Practice Address - Street 2:5700 EAST RIVER ROAD
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2116
Practice Address - Country:US
Practice Address - Phone:763-421-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN$$$$$$$$$Medicaid