Individual
DIANE PEASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 W WAYZATA BLVD, LONG LAKE, MN 55356-1100
(612) 590-1327
Mailing address
2160 W WAYZATA BLVD, LONG LAKE, MN 55356-1100
(612) 590-1327
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
02/24/2016
Last updated
02/24/2016
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