MEDICARE: STEPHANIE LORD MONTOYA LMT

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	6117	MT

General Provider Information

NPI Number	:	1730508185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LORD MONTOYA LMT

Provider Business Mailing Address
First Line	:	1940 HARVE AVE # 2
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-8332
Country	:	US
Telephone Number	:	406-542-0808
Fax Number	:	406-542-0909

Provider Business Practice Location Address
First Line	:	1940 HARVE AVE # 2
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-8332
Country	:	US
Telephone Number	:	406-542-0808
Fax Number	:	406-542-0909

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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Directions to “ STEPHANIE LORD MONTOYA LMT” Practice Location

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