Healthcare Provider Details

I. General information

NPI: 1770920456
Provider Name (Legal Business Name): HAILI ANTHONY MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 OAK ST SUITE D
BOZEMAN MT
59715-2125
US

IV. Provider business mailing address

1707 W OAK ST SUITE D
BOZEMAN MT
59715
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-8446
  • Fax: 406-587-0898
Mailing address:
  • Phone: 406-587-8446
  • Fax: 406-587-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1321
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: