Individual
KRISA LYNN FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCBTMB, BCTMB, LMT
Contact information
Practice address
8120 PENN AVE S STE 100G, BLOOMINGTON, MN 55431-1368
(952) 333-4644
Mailing address
2901 W 70TH ST, RICHFIELD, MN 55423-1906
(612) 430-5190
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
564285-08
MN
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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