Doctor Name: | JESSICA WALD |
NPI Number: | 1275954539 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1136 |
Business Practice Address: | 4401 S 11th St Grand Forks, ND - 582017238 |
Business Phone Number: | 7017327570 |
Business Fax Number: | |
Mailing Address: | 3165 Demers Ave, GRAND FORKS |
State: | ND |
Postal Code: | 582014049 |
Phone Number: | 7017806623 |
Fax Number: | |
NPI Enumeration Date: | 01/03/2014 |
NPI Last Update Date: | 01/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 1136 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |