Healthcare Provider Details

I. General information

NPI: 1154871069
Provider Name (Legal Business Name): EMILY L DULAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 2ND ST W
WHITEFISH MT
59937-3036
US

IV. Provider business mailing address

1141 CATTAIL LN
WHITEFISH MT
59937-7601
US

V. Phone/Fax

Practice location:
  • Phone: 406-314-5800
  • Fax:
Mailing address:
  • Phone: 406-314-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-9835
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: