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General NPI Number Information
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NPI Number | 1366791980
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Entity Type | Individual
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Provider Name | JERUSHA BAKER LMT
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 2825 STOCKYARD RD UNIT H3
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City | MISSOULA
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State | MT
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Zip | 59808-1503
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Country | US
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Telephone | 406-543-1625
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 738
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City | STEVENSVILLE
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State | MT
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Zip | 59870-6104
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Country | US
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Telephone | 406-370-4195
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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 | LMT-LMT-LIC-2009
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License Number State | MT
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