Provider Demographics
NPI:1932330602
Name:PARADISE, LARAMEE JESSEN (CMT)
Entity Type:Individual
Prefix:
First Name:LARAMEE
Middle Name:JESSEN
Last Name:PARADISE
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:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-0944
Mailing Address - Country:US
Mailing Address - Phone:612-232-4669
Mailing Address - Fax:952-955-3833
Practice Address - Street 1:1750 TOWER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-4566
Practice Address - Country:US
Practice Address - Phone:952-443-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist