Healthcare Provider Details

I. General information

NPI: 1134833908
Provider Name (Legal Business Name): SHANA BREWER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N MARSHALL STREET
DARBY MT
59829
US

IV. Provider business mailing address

PO BOX 512
DARBY MT
59829-0512
US

V. Phone/Fax

Practice location:
  • Phone: 406-880-8939
  • Fax:
Mailing address:
  • Phone: 406-880-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-22901
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: