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General NPI Number Information
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NPI Number | 1124396601
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Entity Type | Organization
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Legal Business Name | ANDREA M. ELLESTAD, LLC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 3700 S RUSSELL ST SUITE 106
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City | MISSOULA
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State | MT
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Zip | 59801
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Country | US
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Telephone | 406-203-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 10236 PALE MORNING CT
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-203-6207
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDREA M. ELLESTAD
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Credential | LMT
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Telephone | 406-203-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1098
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License Number State | MT
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