Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | LMT-LMT-LIC-6308 | MT |
NPI | 1003298027 |
---|---|
Provider Name | Megan Upton |
First Address | Columbia Falls, MT 59912-0733 |
Second Address | Columbia Falls, MT 59912-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2015 |
Last Update Date | 25/06/2015 |