Healthcare Provider Details

I. General information

NPI: 1346561917
Provider Name (Legal Business Name): STACIE RAPPAPORT MPT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GIGI RAPPAPORT MPT, LMT

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 ASPEN GROVE ST
WHITEFISH MT
59937-3481
US

IV. Provider business mailing address

PO BOX 224
WHITEFISH MT
59937-0224
US

V. Phone/Fax

Practice location:
  • Phone: 406-270-0969
  • Fax:
Mailing address:
  • Phone: 406-270-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2296
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3956
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: