| NPI | 1720969785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON JONES Office Manager 952-207-2768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225700000X Massage Therapist | |
| 111N00000X Chiropractor | |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |