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General NPI Number Information
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NPI Number | 1578106183
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Entity Type | Organization
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Legal Business Name | THE MISSOULA MERIDIAN
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Dates
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Enumeration Date | 10/26/2019
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Last Update Date | 10/26/2019
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Provider Practice Location Address
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Address Line | 1852 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-6510
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Country | US
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Telephone | 406-926-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 1852 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-6510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANDREA RIVERA
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Credential |
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Telephone | 808-341-4349
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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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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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