Healthcare Provider Details

I. General information

NPI: 1346104148
Provider Name (Legal Business Name): TATE BOLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W OAK ST STE 210
BOZEMAN MT
59715-8757
US

IV. Provider business mailing address

1207 E MAIN ST # 150
BOZEMAN MT
59715-3849
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-8446
  • Fax:
Mailing address:
  • Phone: 307-349-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: