Provider Demographics
NPI:1518795392
Name:PRACTICAL & CREATIVE LLC
Entity type:Organization
Organization Name:PRACTICAL & CREATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DCM, MASSAGE TP
Authorized Official - Prefix:DR
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:MOSQUERA-SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DCM
Authorized Official - Phone:952-303-5780
Mailing Address - Street 1:8120 PENN AVE S STE 248
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1358
Mailing Address - Country:US
Mailing Address - Phone:952-303-5780
Mailing Address - Fax:952-303-6888
Practice Address - Street 1:8120 PENN AVE S STE 248
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1358
Practice Address - Country:US
Practice Address - Phone:952-303-5780
Practice Address - Fax:952-303-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty