Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | LMT-LMT-LIC-7967 | MT |
NPI | 1013491158 |
---|---|
Provider Name | Mr. Tanner J Metz |
First Address | Bozeman, MT 59718-1909 |
Second Address | Bozeman, MT 59718-6409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2018 |
Last Update Date | 24/09/2018 |