Provider Demographics
NPI:1932477676
Name:RONNINGEN, JOEL M (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:M
Last Name:RONNINGEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14036 HEYWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13335 PALOMINO DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55124-4248
Practice Address - Country:US
Practice Address - Phone:651-295-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist