Healthcare Provider Details

I. General information

NPI: 1316651185
Provider Name (Legal Business Name): ERIN FISK 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: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 1/2 A AVE NW
HARLOWTON MT
59036-5328
US

IV. Provider business mailing address

PO BOX 612
HARLOWTON MT
59036-0612
US

V. Phone/Fax

Practice location:
  • Phone: 406-749-0349
  • Fax:
Mailing address:
  • Phone: 406-749-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-13968
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: