Provider Demographics
NPI:1942472592
Name:LUNDELL, LISA M (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LUNDELL
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 1:4220 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3151
Mailing Address - Country:US
Mailing Address - Phone:612-823-8165
Mailing Address - Fax:
Practice Address - Street 1:4220 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3151
Practice Address - Country:US
Practice Address - Phone:612-823-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist