Provider Demographics
NPI:1700250404
Name:REJUV MASSAGE AND BODYWORK LLC
Entity Type:Organization
Organization Name:REJUV MASSAGE AND BODYWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STROM DE MACIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:612-282-0858
Mailing Address - Street 1:8640 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2933
Mailing Address - Country:US
Mailing Address - Phone:612-282-0858
Mailing Address - Fax:
Practice Address - Street 1:8640 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2933
Practice Address - Country:US
Practice Address - Phone:612-282-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty