Healthcare Provider Details

I. General information

NPI: 1154239655
Provider Name (Legal Business Name): THE PINK BUDDHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 2ND ST E STE 209
KALISPELL MT
59901-4500
US

IV. Provider business mailing address

PO BOX 11291
KALISPELL MT
59904-4291
US

V. Phone/Fax

Practice location:
  • Phone: 406-885-2974
  • Fax:
Mailing address:
  • Phone: 406-885-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DANAE
Title or Position: MANAGING MEMBER
Credential: LMT, CMLDT, CNMT
Phone: 406-885-2974