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General NPI Number Information
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NPI Number | 1730550807
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Entity Type | Organization
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Legal Business Name | MASSAJ MAHAL
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 22 2ND AVE W 1100
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City | KALISPELL
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State | MT
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Zip | 59901-4466
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Country | US
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Telephone | 406-755-6002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7923
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City | KALISPELL
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State | MT
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Zip | 59904-0923
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Country | US
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Telephone | 406-755-6002
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Fax | 888-350-5332
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN ERICKSON
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Credential | LMT, BLS, BS
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Telephone | 406-755-6002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1062
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License Number State | MT
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