Muzique Latise Broadnax, CMT, MMP,LMT,CA

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT-27885 Issued in AZ

Practice address

2915 Wayzata Blvd
304
Minneapolis, MN 55405-2145

Phone

(612) 396-2016

NPI assigned

Nov 16, 2010

Last updated

Sep 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1285935726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 E WASHINGTON ST STE 300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850341908",
            "telephone_number": "612-486-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 WAYZATA BLVD",
            "address_2": "304",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052145",
            "telephone_number": "612-396-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "MUZIQUE",
        "middle_name": "LATISE",
        "name_prefix": "Ms.",
        "credential": "CMT, MMP,LMT,CA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-16",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175L00000X",
            "taxonomy_group": "",
            "desc": "Homeopath",
            "state": "MN",
            "license": "938479",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AZ",
            "license": "MT-27885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Massage Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.