Provider Demographics
NPI:1780557686
Name:SOULFULTOUCH LLC
Entity type:Organization
Organization Name:SOULFULTOUCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOMMASOUVANH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-337-9676
Mailing Address - Street 1:11705 COLORADO AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2503
Mailing Address - Country:US
Mailing Address - Phone:763-337-9676
Mailing Address - Fax:
Practice Address - Street 1:11705 COLORADO AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2503
Practice Address - Country:US
Practice Address - Phone:763-337-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty