Provider Demographics
NPI:1942703913
Name:SONTERRE, JODIE MAE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:MAE
Last Name:SONTERRE
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 1:18827 INCA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7565
Mailing Address - Country:US
Mailing Address - Phone:651-592-5040
Mailing Address - Fax:651-286-0946
Practice Address - Street 1:7373 147TH ST W STE 108
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7532
Practice Address - Country:US
Practice Address - Phone:651-592-5040
Practice Address - Fax:651-286-0946
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist