Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | LMT-LMT-LIC-7804 | MT |
NPI | 1003293630 |
---|---|
Provider Name | Cheryl Mcdonald |
First Address | Bozeman, MT 59715-0696 |
Second Address | Bozeman, MT 59715-0696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 04/05/2015 |