Healthcare Provider Details

I. General information

NPI: 1245604057
Provider Name (Legal Business Name): FREDERICK CARL GUENZLER LMT - MT387
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LUBY LANE
FLORENCE MT
59833
US

IV. Provider business mailing address

201 LUBY LN
FLORENCE MT
59833
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-2591
  • Fax:
Mailing address:
  • Phone: 406-777-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT387
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberLMT387
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: