Provider Demographics
NPI:1831590124
Name:ANDREA ZITZLOFF
Entity type:Organization
Organization Name:ANDREA ZITZLOFF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MASSAGE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ZITZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CMP
Authorized Official - Phone:612-328-0884
Mailing Address - Street 1:5258 20TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:MN
Mailing Address - Zip Code:55390-5024
Mailing Address - Country:US
Mailing Address - Phone:612-328-0884
Mailing Address - Fax:
Practice Address - Street 1:5258 20TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:MN
Practice Address - Zip Code:55390-5024
Practice Address - Country:US
Practice Address - Phone:612-328-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty