Provider Demographics
NPI:1770812067
Name:DYNAMIC JOURNEY MASSAGE & WELLNESS, INC.
Entity type:Organization
Organization Name:DYNAMIC JOURNEY MASSAGE & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:952-994-1790
Mailing Address - Street 1:4219 HANREHAN TRL
Mailing Address - Street 2:SCARBOROUGH
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-9786
Mailing Address - Country:US
Mailing Address - Phone:952-994-1790
Mailing Address - Fax:952-746-2819
Practice Address - Street 1:1103 W BURNSVILLE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5800
Practice Address - Country:US
Practice Address - Phone:952-994-1790
Practice Address - Fax:952-746-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1770812067OtherNPI
MN1336478627OtherNPI