Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MN |
NPI | 1003417379 |
---|---|
Provider Name | Amanda R Deowdat |
First Address | Richfield, MN 55423-4091 |
Second Address | Richfield, MN 55423-4091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2020 |
Last Update Date | 04/11/2020 |