Organization
LEVIRG.INC
Active
Other names
Massage Off Central
Organization subpart
No
Provider details
NPI number
Authorized official
LORETTA JANE BROUILLETTE CMT (OWNER/THERAPIST)
(763) 333-2690
Entity
Organization
Contact information
Practice address
11806 ABERDEEN ST NE, SUITE 180, BLAINE, MN 55449-4736
(763) 333-2690
Mailing address
11806 ABERDEEN ST NE, SUITE 180, BLAINE, MN 55449-4736
(763) 333-2690
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15-07259
MN
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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