Provider Demographics
NPI:1942341722
Name:DEETZ, DOROTHY (NCTMB)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:DEETZ
Suffix:
Gender:F
Credentials:NCTMB
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 272
Mailing Address - Street 2:
Mailing Address - City:MARINE ON SAINT CROIX
Mailing Address - State:MN
Mailing Address - Zip Code:55047-0272
Mailing Address - Country:US
Mailing Address - Phone:651-430-2212
Mailing Address - Fax:
Practice Address - Street 1:333 MAIN ST N STE 205
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5054
Practice Address - Country:US
Practice Address - Phone:651-430-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist