Individual
SHANNON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5810 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-2830
(952) 927-8686
Mailing address
5810 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-2830
(952) 927-8686
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
00020768
MN
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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