MEDICARE: MS. ROSEMARY A STOUDT 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	1314	MT
2	225700000X	Massage Therapist	00020119	WA

General Provider Information

NPI Number	:	1982216834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSEMARY A STOUDT LMT

Provider Business Mailing Address
First Line	:	336 S 5TH ST E APT 3
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-2742
Country	:	US
Telephone Number	:	406-880-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N HIGGINS AVE STE 128
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4563
Country	:	US
Telephone Number	:	406-880-8060
Fax Number	:

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

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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Directions to “ MS. ROSEMARY A STOUDT LMT” Practice Location

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