Healthcare Provider Details

I. General information

NPI: 1720992704
Provider Name (Legal Business Name): GRACE TATE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 TRAKKER TRL STE 2E
BOZEMAN MT
59718-9202
US

IV. Provider business mailing address

3701 TRAKKER TRL STE 2E
BOZEMAN MT
59718-9202
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-1313
  • Fax:
Mailing address:
  • Phone: 406-404-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-34343
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: