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General NPI Number Information
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NPI Number | 1124774294
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Entity Type | Individual
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Provider Name | CORINE TILSON LMT
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Gender | Female
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Dates
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Enumeration Date | 02/26/2022
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 1070 N RUSSELL ST
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City | MISSOULA
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State | MT
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Zip | 59808-2004
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Country | US
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Telephone | 406-541-8888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 313
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City | SAINT REGIS
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State | MT
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Zip | 59866-0313
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Country | US
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Telephone | 808-747-1818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4660
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License Number State | ID
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