| Reviving Roots Therapy & Wellness | |
|
3440 Portland Ave Minneapolis MN 55407-4861 | |
| (612) 990-8172 | |
| Not Available |
| Full Name | Reviving Roots Therapy & Wellness |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 3440 Portland Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Marlee Dorsey (PRESIDENT) |
| Authorized Official Contact | 6124457781 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reviving Roots Therapy & Wellness 3440 Portland Ave Minneapolis MN 55407-4861 Ph: (612) 990-8172 | Reviving Roots Therapy & Wellness 3440 Portland Ave Minneapolis MN 55407-4861 Ph: (612) 990-8172 |
| NPI Number | 1548800915 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 09/24/2020 |
| Certification Date | 09/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548800915 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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