Individual
EDWINNA GATES SACKARIASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1901 FREDEEN CT, NEW BRIGHTON, MN 55112-2412
(651) 653-0786
(651) 762-7944
Mailing address
1901 FREDEEN CT, NEW BRIGHTON, MN 55112-2412
(651) 653-0786
(651) 762-7944
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA8782
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103503
ABMP
MN
01
—
7068-00
NCTMB
MN
01
—
MA8782
LICENSE
FL
Enumeration date
09/15/2010
Last updated
09/15/2010
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