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3/12/24. 9:36 AM <br />Revize Online Forms <br />Therapeutic Massage Individual Therapist License <br />Submitted by: Crystal Hoon <br />Submitted On: 2024-03-11 23:21:06 <br />Submission IP: (172.58.11.72) <br />proxy-IP (raw-IP) <br />Status: Open <br />Priority: Normal <br />Assigned To: Barb Benesch <br />Due Date: Open <br />Attachments <br />9 20240311 231740jpg_- 2024-03-11 11:21:07 pm <br />MOUNDS VIEW <br />THERAPEUTIC MASSAGE INDIVIDUAL THERAPIST <br />2401 Mounds View Blvd. I Mounds View, MN 55112 <br />(763) 717-4000 1 Fax (763) 717-4019 1 nfo@moundsviewmn.org I www.moundsviewmn.org <br />New <br />® $102 License/$100 Investigation <br />* BUSINESS NAME (Employer) <br />Minnesota Muscle Recovery, LLC <br />Employer Email <br />mnmusclerecovery@gmail.com <br />APPLICANT INFORMATION <br />* Applicant First Name <br />Crystal <br />Applicant Address <br />2501 Sherwood Rd <br />* Email <br />mnmusclerecovery@gmail.com <br />Renewal <br />❑ $102 License/$50 Investigation <br />* BUSINESS LOCATION <br />801 Front Ave St Paul <br />Tempoary <br />❑ $100 License/$100 Investigation <br />MI * Applicant Last Name <br />D Hoon <br />City <br />* Phone <br />7079536370 <br />Mounds View <br />* Employer Name <br />mnmusclerecovery@gmail.com <br />* Birthdate <br />Format: MM/DD/YYYY <br />State Zip Code <br />MN 55112 <br />* Social Security Number <br />Valid Email Required <br />https://moundsviewmn.rja.revize.com/reports/482442 1/3 <br />