Organization
MASSAGE ON MILLE LACS
Active
Organization
MASSAGE ON MILLE LACS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY GALLATI CMT (OWNER)
(763) 219-0163
Entity
Organization
Contact information
Practice address
295 MAIN ST W # 851, ISLE, MN 56342-4919
(763) 219-0163
Mailing address
295 MAIN ST W # 851, ISLE, MN 56342-4919
(763) 219-0163
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55897
WC AND AUTO
MN
Enumeration date
11/04/2019
Last updated
11/04/2019
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