Healthcare Provider Details

I. General information

NPI: 1134606999
Provider Name (Legal Business Name): NIKITA GUZA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 12TH AVE S
GREAT FALLS MT
59405-4607
US

IV. Provider business mailing address

313 1ST AVE SW
GREAT FALLS MT
59404-2801
US

V. Phone/Fax

Practice location:
  • Phone: 406-453-8885
  • Fax:
Mailing address:
  • Phone: 406-781-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-5989
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: