Provider Demographics
NPI:1740710599
Name:KRIZIC, DANICA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:DANICA
Middle Name:
Last Name:KRIZIC
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 1:5009 EXCELSIOR BLVD STE 141
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3035
Mailing Address - Country:US
Mailing Address - Phone:952-255-9399
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BLVD STE 141
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3035
Practice Address - Country:US
Practice Address - Phone:952-255-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist