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General NPI Number Information
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NPI Number | 1225774516
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Entity Type | Organization
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Legal Business Name | RETREAT TO WELLNESS LC LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 711 CENTRAL AVE STE 223
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City | BILLINGS
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State | MT
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Zip | 59102-5889
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Country | US
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Telephone | 406-927-5554
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Fax | 406-281-8924
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Provider Business Mailing Address
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Address Line | PO BOX 23116
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City | BILLINGS
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State | MT
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Zip | 59104-3116
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Country | US
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Telephone | 406-927-5554
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Fax | 406-371-7286
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Authorized Official
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Title or Position | OWNER
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Name | SHAYLA M GIPSON
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Credential | LMT
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Telephone | 406-927-5554
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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 |
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License Number State |
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