Provider Demographics
NPI:1528660818
Name:WISEMAN, CHERRY ANNE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:ANNE
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 LONSDALE BLVD W
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4720
Mailing Address - Country:US
Mailing Address - Phone:952-393-8750
Mailing Address - Fax:
Practice Address - Street 1:750 S PLAZA DR STE 124
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1505
Practice Address - Country:US
Practice Address - Phone:651-406-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist