Individual
STEPHEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NST, LMT
Contact information
Practice address
1600 UNIVERSITY AVE W STE 10, SAINT PAUL, MN 55104-3898
(651) 646-7246
Mailing address
1600 UNIVERSITY AVE W STE 10, SAINT PAUL, MN 55104-3898
(651) 646-7246
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20130002985
MN
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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