Provider Demographics
NPI:1841015120
Name:EV MASSAGE & WELLNESS LLC
Entity type:Organization
Organization Name:EV MASSAGE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/ SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-258-9047
Mailing Address - Street 1:6916 IDAHO AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1780
Mailing Address - Country:US
Mailing Address - Phone:763-258-9047
Mailing Address - Fax:
Practice Address - Street 1:911 MARYLAND AVE E STE G6
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2647
Practice Address - Country:US
Practice Address - Phone:763-258-9047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty