Provider Demographics
NPI:1205134616
Name:BODY KNEADS MASSAGE, LLC
Entity type:Organization
Organization Name:BODY KNEADS MASSAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BENNETT NORDIN
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB, LMT, CHC
Authorized Official - Phone:651-267-0118
Mailing Address - Street 1:316 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2526
Mailing Address - Country:US
Mailing Address - Phone:651-267-0118
Mailing Address - Fax:
Practice Address - Street 1:316 BUSH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2526
Practice Address - Country:US
Practice Address - Phone:651-267-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty