Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6253 | MT |
NPI | 1003221201 |
---|---|
Provider Name | Denise Trosclair |
First Address | Missoula, MT 59801-3431 |
Second Address | Missoula, MT 59801-3431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 25/06/2014 |