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Individual

FANTA KYSONE SYCHAMPANAKHONE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CMT

Contact information

Practice address
234 PINE CONE RD STE B, SARTELL, MN 56377-2504
(320) 253-5255
(320) 253-5260
Mailing address
234 PINE CONE RD STE B, SARTELL, MN 56377-2504
(320) 253-5255
(320) 253-5260

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
768918
MN

Other

Enumeration date
10/10/2022
Last updated
10/10/2022
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