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General NPI Number Information
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NPI Number | 1427557370
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Entity Type | Organization
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Legal Business Name | WELL KNEADED MASSAGE, INC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 3946 US HIGHWAY 93 N
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City | STEVENSVILLE
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State | MT
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Zip | 59870-6425
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Country | US
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Telephone | 406-360-7491
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Fax |
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Provider Business Mailing Address
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Address Line | 12832 AGATE DR
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City | LOLO
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State | MT
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Zip | 59847-9584
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Country | US
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Telephone | 406-360-7491
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | BRITTNEY JESSOP
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Credential | LMT, BCTMB
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Telephone | 406-360-7491
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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 | 4140
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License Number State | MT
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