MEDICARE: AMY DUNLAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	1112	MT

General Provider Information

NPI Number	:	1053705202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DUNLAP

Provider Business Mailing Address
First Line	:	4600 SUNDOWN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-7106
Country	:	US
Telephone Number	:	406-493-0732
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 DEARBORN AVE
Second Line	:	SUITE 1
City	:	MISSOULA
State	:	MT
Zip	:	59801-7586
Country	:	US
Telephone Number	:	406-552-7613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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Directions to “ AMY DUNLAP ” Practice Location

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