Provider Demographics
NPI:1932267861
Name:KAMPMEYER, TREECE MARY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:TREECE
Middle Name:MARY
Last Name:KAMPMEYER
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 1:1851 COVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2682
Mailing Address - Country:US
Mailing Address - Phone:651-905-9053
Mailing Address - Fax:
Practice Address - Street 1:311 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2323
Practice Address - Country:US
Practice Address - Phone:651-222-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN83851225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
406311OtherABMP
MN3188517OtherSTATE TAX IDENTIFICATION