Fanta Kysone Sychampanakhone, CMT

NPI #1881319085 in Sartell, Minnesota

Provider Information

NPI Number: 1881319085
Entity Type: Individual
Name: Fanta Kysone Sychampanakhone, CMT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Massage Therapist
Credential: CMT
Enumeration Date: Oct 10, 2022
Last Updated: Oct 10, 2022

Practice Location

Address: 234 PINE CONE RD STE B
City: Sartell
State: Minnesota
ZIP Code: 56377-2504
Phone: (320) 253-5255

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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