Healthcare Provider Details

I. General information

NPI: 1649243239
Provider Name (Legal Business Name): REBECCA JO DANE L.M.T. , C. S. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOBILE MASSAGE

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 OLD CORVALLIS RD UNIT S
HAMILTON MT
59840-3213
US

IV. Provider business mailing address

643 GRANTSDALE RD TRLR 17A
HAMILTON MT
59840-3346
US

V. Phone/Fax

Practice location:
  • Phone: 406-375-9416
  • Fax:
Mailing address:
  • Phone: 406-207-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number533
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number533
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number533
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number533
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number533
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: