Basic Information
| Provider Information | |||||||||
| NPI: | 1891142881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALBOT | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MASSAGE THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 MANOR DR NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554321272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637840902 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 305 FREMONT ST | ||||||||
| Address2: | 5700 EAST RIVER ROAD | ||||||||
| City: | ANOKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553032116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7634215660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2016 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.