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General NPI Number Information
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NPI Number | 1861740581
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Entity Type | Individual
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Provider Name | JENNIFER L VANDERBURG LMT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 240 N. HIGGINS #11
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City | MISSOULA
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State | MT
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Zip | 59802
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Country | US
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Telephone | 406-529-1958
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | DIXON
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State | MT
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Zip | 59831
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Country | US
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Telephone | 406-529-1958
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | LMT-LMT-LIC-675
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License Number State | MT
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