Provider Demographics
NPI:1043897010
Name:GRETTE, MADELINE R (CNMT, BCTMB)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:R
Last Name:GRETTE
Suffix:
Gender:F
Credentials:CNMT, BCTMB
Other - Prefix:
Other - First Name:MADDI
Other - Middle Name:
Other - Last Name:BURDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7127 MORGAN AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2939
Mailing Address - Country:US
Mailing Address - Phone:952-261-6877
Mailing Address - Fax:
Practice Address - Street 1:12100 SINGLETREE LN STE 167
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7952
Practice Address - Country:US
Practice Address - Phone:612-567-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty